Our Summary

This research paper is about a woman in her 60s who had a severe eye condition called strabismus fixus due to high myopia (nearsightedness), which affected her right eye. Her eye turned inward more than normal (over 45°) and downward (over 15°). An MRI scan showed damage to certain eye muscles and ligaments.

Doctors decided to perform a strabismus surgery which involved moving and adjusting some muscles in her eye. During this operation, a complication known as the pulled-in-two syndrome happened, where one of the eye muscles being operated on (the medial rectus muscle) got torn.

Instead of trying to do more during the same operation, the doctors decided to wait and perform a second surgery after three months. In the second surgery, they moved the torn muscle forward and adjusted another muscle. After one and a half years, the woman’s eye position was much better and she was happy with the result.

The study suggests that if a similar complication happens during surgery, it’s best to stay calm and plan for a second operation a few months later rather than trying to do everything in one go. This experience could help other doctors make decisions if they face a similar situation in the future.

FAQs

  1. What is strabismus fixus and how does it affect the eyes?
  2. What was the complication that arose during the strabismus surgery and how was it handled?
  3. What is the recommendation for doctors if a similar complication occurs during surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about strabismus surgery is to be aware that complications can sometimes occur during the procedure. If a complication does occur, it’s important to stay calm and trust your doctor’s judgment on the best course of action. In some cases, a second surgery may be necessary to achieve the desired outcome. Patience and following your doctor’s recommendations are key to a successful recovery from strabismus surgery.

Suitable For

Patients who are typically recommended for strabismus surgery are those who have misalignment of the eyes that cannot be corrected with other treatments such as glasses, prisms, or vision therapy. Strabismus surgery may be recommended for patients with:

  1. Constant or frequent eye misalignment that affects their vision or causes discomfort.
  2. Strabismus that is causing double vision.
  3. Strabismus that is affecting the patient’s self-esteem or quality of life.
  4. Patients with neurological conditions such as cerebral palsy, stroke, or traumatic brain injury that have developed strabismus.
  5. Patients with high myopia (nearsightedness) like the woman in the research paper who have developed severe forms of strabismus such as strabismus fixus.

It is important for patients to undergo a comprehensive eye examination and consultation with a strabismus specialist to determine if they are a good candidate for strabismus surgery. The decision to proceed with surgery will depend on the severity of the strabismus, the underlying cause, and the potential risks and benefits of the surgery.

Timeline

Before strabismus surgery:

  • Patient experiences symptoms of strabismus, such as misalignment of the eyes, double vision, or eye strain.
  • Patient undergoes a thorough eye examination, including visual acuity tests, eye muscle testing, and possibly imaging tests like MRI or CT scans.
  • Doctor discusses treatment options with the patient, including the possibility of surgery to correct the alignment of the eyes.

After strabismus surgery:

  • Patient undergoes the surgical procedure to adjust the eye muscles and correct the misalignment.
  • In the case of complications like the pulled-in-two syndrome, doctors may decide to postpone further intervention and plan for a second surgery at a later time.
  • Patient undergoes a second surgery to address any complications or further adjustments needed.
  • Over time, the patient’s eye position improves, and they experience reduced symptoms of strabismus.
  • Follow-up appointments with the doctor are scheduled to monitor the patient’s progress and ensure the success of the surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with strabismus surgery?
  2. How experienced are you in performing strabismus surgery?
  3. What is the success rate for this type of surgery in patients with similar conditions?
  4. What is the expected recovery time and post-operative care for this surgery?
  5. What are the alternatives to surgery for treating strabismus?
  6. Will I need to wear an eye patch or use eye drops after the surgery?
  7. How long will it take for my vision to improve after the surgery?
  8. Will I need to undergo any follow-up procedures or treatments after the surgery?
  9. Are there any specific lifestyle changes I should make before or after the surgery?
  10. How will this surgery affect my daily activities and overall quality of life?

Reference

Authors: Nakao S, Miyata M, Hirai M, Mizoguchi S, Ohashi H, Nishiwaki H. Journal: Medicine (Baltimore). 2022 Dec 30;101(52):e31864. doi: 10.1097/MD.0000000000031864. PMID: 36596031