Our Summary

The study looked at the results of eye muscle surgery (strabismus surgery) in patients who had previously had a device implanted to help with glaucoma. This was done by looking back at the medical records of patients who had both surgeries at the same institution over 13 years.

The study found that of the 16 patients, most had an outward turning eye (exotropia) and some had vertical deviations. Before the eye muscle surgery, more than half of the patients were experiencing double vision (diplopia).

In the surgery, the approach was adjusted based on what the patient was most bothered by - whether it was the horizontal or vertical deviation. Three patients had both types of surgery at the same time. All of the patients had the eye muscle surgery on the eye that had the glaucoma device.

After the surgery, less than half of the patients achieved what is considered a successful outcome based on standard measurements. However, the majority of patients did see a decrease in the severity of their deviation. Half of the patients who had been experiencing double vision no longer had it after the surgery.

One patient experienced a complication during the surgery, but none had complications afterwards. Only two needed to have a second eye muscle surgery.

In conclusion, eye muscle surgery can be safely performed in patients who have previously had a glaucoma device implanted and can improve the alignment of the eye and related symptoms. However, the success rate based on standard measurements is low.

FAQs

  1. What is the purpose of strabismus surgery on eyes with prior glaucoma drainage device implantation?
  2. What were the success rates of strabismus surgery in correcting horizontal and vertical deviations?
  3. Were there any complications noted post-strabismus surgery on patients with a glaucoma drainage device?

Doctor’s Tip

A helpful tip a doctor might tell a patient about strabismus surgery in the presence of a glaucoma drainage device is to ensure that the surgical approach is tailored to address the deviation most noticeable to the patient, whether it be horizontal, vertical, or both. Additionally, it is important to discuss the potential risks and benefits of the surgery, including the possibility of diplopia resolution and improvement in ocular alignment. It is also important to follow postoperative care instructions carefully to optimize outcomes and minimize the risk of complications.

Suitable For

Patients who are typically recommended for strabismus surgery following implantation of a glaucoma drainage device include those with ocular misalignment, such as exotropia and vertical deviations, that develop after the GDD procedure. Patients may also have diplopia as a symptom. The surgical approach is tailored to address the specific type of deviation that is most noticeable to the patient, whether it is horizontal, vertical, or a combination of both. In some cases, simultaneous horizontal and vertical surgery may be performed. The study found that strabismus surgery in these patients can lead to improvements in ocular alignment and related symptoms, with a low risk of complications such as bleb perforation or postoperative hypotony.

Timeline

Before strabismus surgery:

  • Patient undergoes implantation of a glaucoma drainage device
  • Patient develops ocular misalignment (exotropia, vertical deviations)
  • Preoperative measurements are taken to assess the deviation
  • Patient may experience diplopia
  • Surgical approach is tailored to address the most noticeable deviation

After strabismus surgery:

  • Patient undergoes strabismus surgery on an eye with a GDD
  • Surgical motor success is achieved in a percentage of horizontal and vertical deviations
  • Deviations decrease in magnitude postoperatively
  • Diplopia may resolve in some patients
  • Complications such as intraoperative bleb perforation are rare
  • Some patients may require a second strabismus surgery

What to Ask Your Doctor

  1. What are the potential risks and complications associated with strabismus surgery in eyes with prior implantation of a glaucoma drainage device?

  2. How will the presence of the glaucoma drainage device affect the surgical approach and outcomes of the strabismus surgery?

  3. What are the expected outcomes and success rates of strabismus surgery in eyes with a glaucoma drainage device?

  4. Will the strabismus surgery have any impact on the function or effectiveness of the glaucoma drainage device?

  5. How long is the recovery period expected to be following strabismus surgery in eyes with a glaucoma drainage device?

  6. Are there any specific postoperative care instructions that need to be followed to ensure the best possible outcome?

  7. Will additional follow-up appointments be necessary after the strabismus surgery to monitor both the ocular alignment and the function of the glaucoma drainage device?

  8. Are there any alternative treatment options or considerations that should be taken into account before proceeding with strabismus surgery in this scenario?

  9. Can the improvement in ocular alignment from the strabismus surgery potentially have any impact on the management of the glaucoma in the affected eye?

  10. How experienced is the surgeon in performing strabismus surgery in eyes with prior implantation of a glaucoma drainage device, and what is their success rate in similar cases?

Reference

Authors: Osigian CJ, Cavuoto KM, Rossetto JD, Sayed M, Grace S, Chang TC, Capo H. Journal: J AAPOS. 2017 Apr;21(2):103-106.e2. doi: 10.1016/j.jaapos.2017.03.004. Epub 2017 Mar 9. PMID: 28286307