Our Summary

This study looks at a rare complication that can occur during eye surgeries for strabismus, a condition where the eyes don’t look in the same direction at the same time. The complication is called “pulled-in-two syndrome” (PITS) and it was found in six patients who had surgery at the Beyoglu Eye Training and Research Hospital between January 2000 and March 2022.

All of these patients had a condition called congenital fibrosis of extraocular muscles (CFEOM), which is abnormal scarring and stiffness of the muscles that move the eye. The muscle that was most often involved in PITS was the medial rectus, which helps turn the eye towards the middle of the face. Most of the patients were adults.

In all cases, the surgeons were able to find the muscle that had been pulled in two and reattach it to the eyeball. None of the patients had double vision after their surgery.

The results of this study suggest that patients with CFEOM are at risk for PITS during strabismus surgery, so surgeons should be aware of this and prepared to deal with it if it happens.

FAQs

  1. What is “pulled-in-two syndrome” (PITS) that can occur during strabismus surgery?
  2. How is the complication of pulled-in-two syndrome (PITS) managed during surgery?
  3. Are patients with congenital fibrosis of extraocular muscles (CFEOM) at higher risk for PITS during strabismus surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about strabismus surgery is to make sure they follow all post-operative care instructions carefully to ensure proper healing and reduce the risk of complications like PITS. It’s important to attend all follow-up appointments with the surgeon to monitor progress and address any concerns promptly. Additionally, patients should communicate any changes in their vision or discomfort to their doctor right away. Taking these precautions can help ensure a successful outcome from the surgery.

Suitable For

Patients with strabismus who have conditions such as congenital fibrosis of extraocular muscles (CFEOM) or other abnormalities in the muscles that move the eye are typically recommended for strabismus surgery. Additionally, patients who have not responded well to other forms of treatment such as vision therapy or eye exercises may also be recommended for surgery. The decision to recommend surgery is usually based on the severity of the strabismus and the impact it has on the patient’s vision and quality of life.

Timeline

Before strabismus surgery, a patient typically undergoes a comprehensive eye examination to determine the severity of their condition and the best course of treatment. The patient may also undergo vision therapy or use corrective lenses to manage their symptoms.

During the surgery, the ophthalmologist will make small incisions in the eye muscles to reposition them and improve alignment. The surgery is usually performed under general anesthesia and typically takes around 1-2 hours.

After the surgery, the patient may experience some discomfort, redness, and swelling in the eye area. They will be prescribed eye drops or ointments to prevent infection and aid in healing. It is important for the patient to follow post-operative care instructions provided by the surgeon to ensure a successful recovery.

In the weeks following the surgery, the patient will have follow-up appointments with the ophthalmologist to monitor their progress and make any necessary adjustments. It may take several weeks for the eyes to fully align and for the patient to experience improved vision and eye coordination.

Overall, strabismus surgery can significantly improve the patient’s quality of life by correcting misalignment and improving visual function.

What to Ask Your Doctor

Some questions a patient should ask their doctor about strabismus surgery include:

  1. What are the potential risks and complications of strabismus surgery, including the risk of pulled-in-two syndrome?
  2. How experienced are you in performing strabismus surgery, particularly in patients with congenital fibrosis of extraocular muscles?
  3. What is the success rate of strabismus surgery in patients with my specific condition?
  4. What is the recovery process like after strabismus surgery, and what kind of follow-up care will be needed?
  5. Are there any alternative treatments or therapies that could be considered before opting for surgery?
  6. Can you provide me with information about the specific surgical technique you plan to use for my case?
  7. What are the expected outcomes of strabismus surgery in terms of improving my eye alignment and vision?
  8. Are there any lifestyle changes or precautions I should take before or after the surgery?
  9. How long will the effects of strabismus surgery last, and will I need additional procedures in the future?
  10. Are there any specific questions or concerns I should discuss with you before proceeding with strabismus surgery?

Reference

Authors: Dizdar Yigit D, İnal A, Gürez C, Gokyigit B. Journal: Strabismus. 2023 Jun;31(2):135-138. doi: 10.1080/09273972.2023.2231032. Epub 2023 Jul 31. PMID: 37519154