Evaluation of single-stage adjustable strabismus surgery under conscious sedation

Abstract

PurposeTo evaluate the feasibility and stability of ocular alignment after single-stage adjustable strabismus surgery (SSASS) performed under topical anesthesia.Materials and MethodsForty-five patients of concomitant exodeviations were randomized into three groups of 15 cases each and were operated with three different techniques: Group I - conventional surgery, Group II - two-stage adjustable suture technique with suture adjustment performed 6h postoperatively and Group III- SSASS under topical anesthesia and intravenous conscious sedation with midazolam and fentanyl. Intraoperative suture adjustment was done by giving a cross target to the patient on the ceiling at the end of the procedure. Surgical results were compared among the three groups at three months follow-up. Intraoperative hemodynamic parameters and patients' experience of the surgery (by questionnaire) were also compared.ResultsMean preoperative deviation for distance in Groups I, II, III was −41.67 prism diopter (pd) ±9.0, −38.93 pd ±11.05 and −41.87 pd ±8.91 (P=0.6) respectively. At three months, mean correction achieved for distance was +31.87 pd ±11.71, +35.47 pd ±10.86 and +42.80 pd ±10.71 respectively which was significantly different between Group III and Group I (P =0.03). Intraoperatively all hemodynamic parameters remained stable and comparable (P=0.5) in all groups. Intraoperative pain (P<0.001) and time taken for surgery (P<0.001) was more in the SSASS group. Amount of exodrift was 10-12 pd, comparable in all three groups (P = 0.5).ConclusionsSSASS, performed under topical anesthesia, is safe and has better outcomes than conventional recession-resection surgery for concomitant exodeviation. An overcorrection of about 10-12 pd is recommended to check the exodrift and achieve stable alignment.

The efficacy of intravenous ketorolac for pain relief in single-stage adjustable strabismus surgery: a prospective, randomized, placebo-controlled trial

“…Despite these risks, single-stage adjustable surgery is known to be a safe procedure. 6,[15][16][17][18][19] The success rate of single-stage adjustable surgery is comparable to that observed in previous studies of two-stage adjustment surgery performed under general or retrobulbar anaesthesia. 5,20,21 The primary disadvantages of single-stage adjustable surgery under topical anaesthesia include a longer procedure time and more intraoperative pain and discomfort of the patient.…”

“…15 The adjustable suture technique requires a fully awake and cooperative patient, recovery from anaesthesia, and return of muscle function. 2 A certain period of time is required for full recovery when peribulbar, retrobulbar, or general anaesthesia is used for strabismus surgery.…”

“…5,20,21 The primary disadvantages of single-stage adjustable surgery under topical anaesthesia include a longer procedure time and more intraoperative pain and discomfort of the patient. 15,22 In order to decrease pain and patient discomfort, we evaluated the effect of a single dose of intravenous ketorolac on intraoperative and postoperative pain during single-stage adjustable surgery in a prospective, randomized, placebo-controlled trial. Ketorolac is a NSAID with an analgesic effect that becomes effective 30 min after dosing and reaches a maximum effect at 2 h. 23 The duration of strabismus surgeries is often short, and it would presumably be more effective to administer ketorolac before the surgical incision instead of at the completion of surgery.…”

Effect of different depths of anesthesia on postoperative cognitive function in laparoscopic patients: a randomized clinical trial

“…Meanwhile, the incidence of POCD in patients can be decreased through reasonable adjusting of factors that are associated with the depth of anesthesia. Many studies reported that bispectral index (BIS) had a good correlation with the depth of many anesthetic agents 6,7 . The lower BIS value indicated the more depth of anesthesia 8 .…”

Strabismus Surgery Reoperation Rates With Adjustable and Conventional Sutures

“…To our knowledge, only one small randomized clinical trial (RCT) of adjustable versus conventional sutures has been performed. 10 In this trial, 45 patients were divided into three equal groups: Group 1 received conventional surgery; Group 2 underwent two-stage adjustable suture technique with adjustment performed six hours post-operatively; and Group 3 underwent adjustable suture technique with adjustment performed at the end of the case. Although the investigators reported that the adjustable suture technique was safe and had better outcomes, intraoperative pain and duration of surgery were greater in the adjustable suture groups.…”