Our Summary

This research paper looks at the results of a specific type of eye surgery for children with a severe form of glaucoma, a disease that damages the eye’s optic nerve. The surgery in question is strabismus surgery, which corrects misaligned eyes, and was performed either after or at the same time as the implantation of a glaucoma drainage device (GDD).

The medical records of 25 children who underwent these surgeries were studied. The researchers looked at various pieces of information, such as the children’s age and sex, their vision before and after surgery, the type of glaucoma they had, the type and location of the GDD, and the specific details of the surgeries.

The results showed that the surgeries often improved the alignment of the children’s eyes, but not always to the degree that would be considered successful based on strict standards. In the group of children who had strabismus surgery after GDD implantation, eye alignment improved in 64% of the cases, but none met the strict success criteria. In the group who had both surgeries at the same time, alignment improved in 79% of the cases, with 29% meeting the strict success criteria. No surgical complications were reported in either group.

The paper concludes that while strabismus surgery can often improve eye alignment in children with severe glaucoma, achieving complete success is difficult. This is due to various challenges, including the small size of children’s eye sockets, scarring from the GDD implantation, and the fact that children with severe glaucoma often have poor vision and limited use of both eyes together.

FAQs

  1. What is the purpose of the study on strabismus surgery and glaucoma drainage device implantation?
  2. What were the results of the strabismus surgery in patients with glaucoma drainage device implantation?
  3. What are the challenges associated with strabismus surgery in eyes with existing or planned GDDs for childhood glaucoma?

Doctor’s Tip

A helpful tip a doctor might tell a patient about strabismus surgery after or concomitant with glaucoma drainage device (GDD) implantation is to have realistic expectations. While the surgery can improve alignment, it may not always meet strict criteria for success due to the unique challenges posed by childhood glaucoma. It is important to follow postoperative instructions carefully and attend follow-up appointments to monitor progress and address any concerns.

Suitable For

Patients who are typically recommended strabismus surgery include those with refractory childhood glaucoma who have undergone or are planning to undergo glaucoma drainage device (GDD) implantation. These patients may have motility restrictions, alignment issues, and scarring related to the GDD surgery, which can affect their eye alignment. Strabismus surgery in these patients can help improve alignment, but may not always meet strict criteria for success due to the challenges posed by childhood glaucoma and GDD surgery. It is important for these patients to be carefully evaluated by a specialized ophthalmologist to determine the best course of treatment.

Timeline

Before strabismus surgery, a patient typically undergoes a comprehensive eye examination to assess the extent of the misalignment and determine the best course of treatment. This may include tests to evaluate visual acuity, eye muscle movements, and alignment of the eyes. The patient may also undergo imaging studies such as MRI or CT scans to assess the underlying cause of the strabismus.

After the decision is made to proceed with surgery, the patient will undergo preoperative preparation which may include fasting, stopping certain medications, and receiving instructions on postoperative care. The surgery itself is typically performed under general anesthesia, although some cases may be done under local anesthesia. During the surgery, the eye muscles are adjusted to improve alignment and coordination of the eyes.

After strabismus surgery, the patient will typically experience some discomfort, swelling, and redness in the eye area. Pain medications and eye drops may be prescribed to help manage these symptoms. The patient will also be advised on postoperative care, including how to protect the eyes, avoid strenuous activities, and use eye drops as prescribed. Follow-up appointments will be scheduled to monitor progress and make any necessary adjustments to the treatment plan.

Overall, the timeline for a patient before and after strabismus surgery involves initial evaluation, preoperative preparation, surgery, postoperative recovery, and follow-up care to ensure optimal outcomes and alignment of the eyes.

What to Ask Your Doctor

  1. What is the success rate of strabismus surgery in patients who have undergone or are planning to undergo glaucoma drainage device (GDD) implantation for childhood glaucoma?

  2. What are the potential risks or complications of undergoing strabismus surgery in conjunction with GDD implantation?

  3. How soon after GDD implantation can strabismus surgery be safely performed?

  4. Will the presence of the GDD affect the surgical approach or technique for strabismus correction?

  5. What are the expected outcomes and recovery time following strabismus surgery in patients with childhood glaucoma who have undergone GDD implantation?

  6. Are there any alternative treatment options or considerations for addressing strabismus in patients with childhood glaucoma and GDDs?

  7. How will the presence of the GDD impact the long-term stability of the strabismus correction achieved through surgery?

  8. Will ongoing monitoring or follow-up care be needed to assess the effectiveness of the strabismus surgery in patients with childhood glaucoma and GDDs?

Reference

Authors: Lee AR, Talsania SD, Go M, Freedman SF. Journal: J AAPOS. 2019 Apr;23(2):83.e1-83.e8. doi: 10.1016/j.jaapos.2018.12.006. Epub 2019 Mar 15. PMID: 30885808