Strabismus surgery in the setting of glaucoma drainage devices in the pediatric population

Concurrent adjacent strabismus surgery with glaucoma drainage device placement in childhood glaucomas

“…Nevertheless, as in our study, strabismus surgery involved an adjacent rectus muscle, with similar amounts of recession. Both studies showed modest success rates for strabismus surgery (29% vs. 38% patients) while 11 of the 14 patients in Lee et al had a postoperative decrease in horizontal deviation, all of the patients in our study had decreased angle postoperatively [ 2 ]. It is not surprising that the improvement in alignment did not coincide with better VA in our study.…”

“…Despite the frequency of strabismus in children with glaucoma, to the best of our knowledge there has only been 1 other report of simultaneous strabismus surgery with GDD placement [ 2 ]. In Lee et al, 14 children had combined strabismus-GDD surgery and similar to our study the majority had LR recession for XT.…”

“…For the glaucoma specialist, while IOP control is the top priority, it is important to consider the strabismus during preoperative evaluation. Addressing the strabismus, especially an exodeviation, after a GDD is placed, is more complicated and less predictable due to scarring between the bleb, plate and muscle.2, 7 In addition, in order to fully release the overlying muscle, the capsule of the plate may need to be excised [ 2 , 7 ]. This could lead to early post-operative hypotony, but result in eventual encapsulation with increased IOP due to stimulation of the wound healing response.…”

“…Treatment of the strabismus in this setting is primarily surgical, however, glaucoma drainage devices (GDDs) can induce an additional restrictive component in both children and adults [ 1 , 3 , 6 – 9 ]. Additionally, placement of a GDD makes adjacent rectus muscle surgery more complicated and less predictable, often requiring hang-back sutures and removal of the capsule surrounding the plate [ 2 , 7 ]. Nevertheless, concurrent strabismus surgery with GDD placement is not commonplace, which may be due to the need for expertise in both strabismus and glaucoma surgeries.…”