Strabismus surgery made simple: Dr. Madhu Karna Strabismologist

Strabismus surgery only after amblyopia has been fully treated.

1. Strabismus Resurgery Strabismus Resurgery
made made SimpleSimple
Dr. Madhu KarnaDr. Madhu Karna
StrabismologistStrabismologist

2. After first surgeryAfter first surgery

3. 6 months Postop turns into 6 months Postop turns into
Consecutive exotropiaConsecutive exotropia
realigned after Resurgeryrealigned after Resurgery

4. TipTip
Risk factors for overcorrection- A pattern, Risk factors for overcorrection- A pattern,
amblyopia, high hyperopia.amblyopia, high hyperopia.
Risk factors for undercorrection –amblyopia. Risk factors for undercorrection –amblyopia.
**Strabismus surgery only after amblyopia Strabismus surgery only after amblyopia
has been fully treatedhas been fully treated..

5. Right eye third nerve palsy after Right eye third nerve palsy after
two squint surgeriestwo squint surgeries

6. Using props on the glasses to lift Using props on the glasses to lift
the lid after alignment from the lid after alignment from
previous surgeriesprevious surgeries

7. Residual exotropia or progession of Residual exotropia or progession of
palsy - Reinvestigatepalsy - Reinvestigate

8. Meningioma posterior clinoidMeningioma posterior clinoid

9. TrickTrick

First surgery resultFirst surgery result

Progressive problemProgressive problem

Unmasking of other components - Unmasking of other components -
Reoperations inevitableReoperations inevitable

11. Operated infantile esotropia Operated infantile esotropia
presenting with DVDpresenting with DVD

12. PostopPostop

14. When to reoperateWhen to reoperate
At least 2 months after the initial surgery At least 2 months after the initial surgery
except:except:
Lost or slipped muscleLost or slipped muscle
Large overcorrection after an SO tuckLarge overcorrection after an SO tuck
Large vertical deviations induced by Large vertical deviations induced by
muscle transposition proceduresmuscle transposition procedures

15. This squint may trap you by This squint may trap you by
seeming simple butseeming simple but
HYPEROPIA WITH EXOTROPIAHYPEROPIA WITH EXOTROPIA

16. Before you operate Before you operate
this patientthis patient
Just remove the Just remove the
glassesglasses

17. Esotropia without glasses !!Esotropia without glasses !!

19. High hyperopia with Accomodative High hyperopia with Accomodative
Esotropia with Consecutive ExotropiaEsotropia with Consecutive Exotropia
Reduce hyperopic power by halfReduce hyperopic power by half
If exotropia still manifest or there is a drop If exotropia still manifest or there is a drop
in visual acuity then operate on the in visual acuity then operate on the
consecutive Exotropia after measuring consecutive Exotropia after measuring
over maximum cyclopegic refraction.over maximum cyclopegic refraction.

20. Conservative Vs AggressiveConservative Vs Aggressive
Sensory strabismus mainly sensory Sensory strabismus mainly sensory
exotropia exotropia
Do FDT Do FDT
Release the restrictions and do maximum Release the restrictions and do maximum
recess- resect recess- resect
Inferior Oblique and SO can be weakened Inferior Oblique and SO can be weakened
which are additional abductorswhich are additional abductors..

Raab, unilateral 4 muscle study for large Raab, unilateral 4 muscle study for large
angle exotropia, Ophthal, 1979: 86, 1441angle exotropia, Ophthal, 1979: 86, 1441

21. Consecutive Exo operated twice Consecutive Exo operated twice
earlierearlier

22. PostopPostop

23. END- Effort Never DiesEND- Effort Never Dies
Reop expected in 5-10% of patients who Reop expected in 5-10% of patients who
undergo squint surgeryundergo squint surgery
Any reop introduces a 33% probability of yet Any reop introduces a 33% probability of yet
another procedureanother procedure
We will make 100% effort to make this the last We will make 100% effort to make this the last
squint surgery neededsquint surgery needed

24. We really don’t learn anything from our We really don’t learn anything from our
experience we only learn from reflecting experience we only learn from reflecting
on our experience.on our experience.

25. Strabismus surgery only after amblyopia Strabismus surgery only after amblyopia
has been fully treatedhas been fully treated
Progressive problem Progressive problem
Operate on the consecutive Exotropia Operate on the consecutive Exotropia
after measuring over maximum cyclopegic after measuring over maximum cyclopegic
refractionrefraction
 In Sensory Exotropias Inferior Oblique In Sensory Exotropias Inferior Oblique
and SO can be weakened which are and SO can be weakened which are
additional abductors additional abductors

26. THANK YOUTHANK YOU