Strabismus Resurgery Strabismus Resurgery made made SimpleSimple

Dr. Madhu KarnaDr. Madhu KarnaStrabismologistStrabismologist

After first surgeryAfter first surgery

6 months Postop turns into 6 months Postop turns into Consecutive exotropiaConsecutive exotropia

realigned after Resurgeryrealigned after Resurgery

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..

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

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

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

Meningioma posterior clinoidMeningioma posterior clinoid

TrickTrick

First surgery resultFirst surgery result

Progressive problemProgressive problem

Unmasking of other components - Unmasking of other components - Reoperations inevitableReoperations inevitable

Operated infantile esotropia Operated infantile esotropia presenting with DVDpresenting with DVD

PostopPostop

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

This squint may trap you by This squint may trap you by seeming simple butseeming simple but

HYPEROPIA WITH EXOTROPIAHYPEROPIA WITH EXOTROPIA

Before you operate Before you operate this patientthis patient

Just remove the Just remove the glassesglasses

Esotropia without glasses !!Esotropia without glasses !!

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.

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 angle Raab, unilateral 4 muscle study for large angle

exotropia, Ophthal, 1979: 86, 1441exotropia, Ophthal, 1979: 86, 1441

Consecutive Exo operated twice Consecutive Exo operated twice earlierearlier

PostopPostop

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

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.

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

THANK YOUTHANK YOU