Our Summary

This research paper is a review of all the available literature about a serious complication that can occur during eye surgery, specifically strabismus surgery, which is used to correct misaligned eyes. This complication, known as scleral perforation, is when there is a hole or tear in the white part of the eye. The review found that the chances of this happening during surgery range from 3 in 1,000 to almost 8%.

Certain factors increase the risk of this happening. The most common risk factor is a specific type of eye muscle adjustment called rectus muscle recession. Other risk factors include nearsightedness, having had eye muscle surgery before, the surgeon’s experience, the use of a particular type of needle, reattaching the muscle to a different spot than where it was originally, operating on a certain type of eye muscle, and being young.

The paper also found that there are different opinions on how to treat this type of perforation. Some eye doctors suggest using a type of treatment that involves freezing or using a laser, while others only use these treatments for more serious cases. One study recommended using antibiotic therapy to prevent eye infection, and some eye doctors already use this method.

FAQs

  1. What is the incidence of scleral perforation as a complication of strabismus surgery?
  2. What are the risk factors for scleral perforation in strabismus surgery?
  3. What are the different views on managing scleral perforation post-strabismus surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about strabismus surgery is to follow post-operative care instructions carefully to reduce the risk of complications such as scleral perforation. This may include avoiding rubbing or putting pressure on the eyes, taking prescribed medications as directed, attending follow-up appointments, and contacting the doctor immediately if any concerning symptoms develop.

Suitable For

Patients who are typically recommended strabismus surgery are those with misaligned eyes (strabismus) that cannot be corrected with non-surgical methods such as glasses, eye exercises, or vision therapy. Strabismus surgery may be recommended for patients who have a constant or intermittent eye turn, double vision, or amblyopia (lazy eye). The decision to undergo strabismus surgery is typically made by an ophthalmologist or pediatric ophthalmologist after a thorough evaluation of the patient’s eye alignment and vision.

Timeline

Before strabismus surgery:

  • Patient undergoes pre-operative testing and consultation with the ophthalmologist
  • Patient may need to stop taking certain medications or adjust their current medications
  • Patient may need to fast before the surgery
  • Patient is informed about the risks and benefits of the surgery

After strabismus surgery:

  • Patient may experience discomfort, redness, and swelling in the eye
  • Patient may need to wear an eye patch or protective shield for a few days
  • Patient may need to use eye drops or ointment to prevent infection and promote healing
  • Patient may need to follow up with the ophthalmologist for post-operative care and monitoring
  • Patient may need to undergo vision therapy or other treatments to improve eye alignment and function

What to Ask Your Doctor

  1. What is the likelihood of scleral perforation as a complication of strabismus surgery?
  2. What are the risk factors that may increase the likelihood of scleral perforation during surgery?
  3. How experienced is the surgeon in performing strabismus surgery and minimizing the risk of complications?
  4. What steps will be taken to prevent and manage scleral perforation during surgery?
  5. What are the potential consequences of scleral perforation and how will they be addressed post-operatively?
  6. Will antibiotic therapy be used for endophthalmitis prophylaxis following surgery?
  7. What is the expected recovery time and outcome following strabismus surgery involving scleral perforation?
  8. Are there any alternative treatment options or surgical techniques that may reduce the risk of complications like scleral perforation?

Reference

Authors: Hashim I, Al-Haddad C. Journal: J Pediatr Ophthalmol Strabismus. 2022 Jul-Aug;59(4):214-223. doi: 10.3928/01913913-20211019-02. Epub 2021 Dec 20. PMID: 34928765