Strabismus surgery in children: The prospects for binocular single vision

Abstract

SummaryThe restoration or maintenance of useful binocular single vision (BSV) represents the ideal outcome in the management of a squinting child. However, in planning such management it is essential to have a clear appreciation of the likelihood of attaining that goal , and what factors will help in its attainment.Using both a literature review and some preliminary information from our own patient database we examine the prospects for BSV in different strabismus groups.We also discuss the techniques available to allow prediction of which children are candidates for the development of BSV following squint correction.The ideal outcome in the management of a squinting child is the restoration or establish ment of binocular single vision (BSV) and motor fusion. With these goals secured the strabismus surgeon can look forward to the long-term stability of the surgical result. If these objectives cannot be achieved then the natural progression towards divergence with increasing agel will tend to give rise to increas ing numbers of cosmetically unsatisfactory results and to late surgical correction of con secutive exotropia with the attendant risk of intractable diplopia.Our surgical objectives, be they orthopho ria, deliberate undercorrection or deliberate overcorrection should, therefore, be guided by the expectation of useful BSV resulting from treatment. This review examines some of the theoretical considerations reiating to different types of straol'2>ffius, ano. sup plements those considerations with infor mation obtained from interrogation of our own patient database. The database consists of consecutive patients followed for at least five years, and while currently small, provides useful additional information. We also exam ine some of the ways in which the likelihood of developing BSV may be predicted in any indi vidual child. Esotropia(a) Congenital! Early Infantile An extensive literature on this group of patients has flourished, largely because it represents a discrete, easily identified cohort. The major discussion centres on the timing of surgical intervention, the prospects for BSV and the quality of BSV obtained.2.3.4.5 When evaluating such reports care must be exer cised in assessing the different results reported using different tests of BSV. Particu larly, as Harcourt and Mein point out, the presence of motor fusion in the early post operative period does not necessarily corre late with stable BSV later.6 Nonetheless, it does appear that a significant proportion of such children will develop microtropia with stereopsis if corrected to within 10 prism dioptres by two years of age/ and that this outcome greatly reduces the risk of consecCorrespondence to:

Bimedial hang-back recession— outcomes and surgical response

“…1 Three patients in this series were exotropic post bimedial rectus recessions, although a good cosmetic outcome was subsequently achieved after a second procedure. Regression analysis including data from these patients violated linear regression assumptions, with model residuals not normally distributed.…”

“…Case notes from one institution (Manchester Royal Eye Hospital, UK) were reviewed of all patients undergoing 'hang-back' bimedial rectus recessions during a 4 1 2 period (June 1995-December 1999). All surgery and patient care was carried out or directly supervised by one surgeon (ICL).…”

Long-term surgical outcomes of infantile-onset esotropia in preterm patients compared with full-term patients

“…Several studies also report that preterm birth is related to poor surgical outcomes for esotropia 1 4 5. Surgery to correct strabismus is often delayed in this group of children to allow the amount of deviation to stabilise,3 6 and the delay has been suggested as a reason for the poor prognosis 4. Neurological deficits that often accompany preterm birth could also contribute to the poor prognosis of strabismus surgery in this population.…”

Silicone Band in the Surgical Treatment of Manifest Exotropia

“…Several processes are implicated in the exodeviation genesis but neurological lesions [1] are the most frequent. Surgical technique is planned according to deviation grade, sensory status and age of the patients [2,3] and it includes bilateral lateral rectus recession and/ or unilateral medial rectus resection (which is strictly related with the primary deviation degree [4][5][6]). The use of adjustable sutures might represent an effective aid in the surgical management [7] as well as dominant or non-dominant eye surgery might produce different functional outcomes [8,9].…”