Our Summary

The paper is about strabismus correction surgery, which is the most common eye operation in children. Strabismus is a condition where the eyes don’t properly align with each other, and about 4% of adults are at risk of developing it. There are several ways to treat strabismus, such as using certain drugs, different types of surgeries, or less invasive procedures. However, these treatments often need to be repeated because they only successfully correct the problem 60%-80% of the time.

Even though anesthesia has risks, the paper argues that the benefits of correcting strabismus early in children outweigh these risks. General anesthesia can be used for patients of any age and for more complex or repeated surgeries. A regional ophthalmic block can reduce some risks and provide pain relief after surgery, but it can be uncomfortable and requires the patient to cooperate. Topical anesthesia is another option and can be used in several types of procedures, but it’s only suitable for adults who can cooperate.

The paper suggests using both ondansetron and dexamethasone to prevent vomiting, especially in children. It also recommends using a combination of different pain relief methods after surgery, including paracetamol, intravenous non-steroidal anti-inflammatory drugs, topical local anesthetic, and minimal opioid usage. A regional ophthalmic block can also be used after surgery, but this is up to the medical team.

FAQs

  1. What are the current treatment options for strabismus?
  2. What are the benefits of early surgical correction in large-angle strabismus in children?
  3. What is the recommended approach for postoperative analgesia after strabismus surgery?

Doctor’s Tip

One helpful tip a doctor might give a patient about strabismus surgery is to follow all pre-operative instructions provided by the surgeon, including fasting before the surgery and avoiding certain medications. It is also important to communicate any concerns or questions with the medical team and to follow all post-operative care instructions for optimal healing and recovery.

Suitable For

Patients who are typically recommended strabismus surgery include:

  1. Children with large-angle strabismus: Early surgical correction is beneficial in children with large-angle strabismus as it can improve their visual function and prevent amblyopia.

  2. Adults with strabismus: Adults with a 4% lifetime risk of developing strabismus may be recommended surgery to correct their eye misalignment.

  3. Patients requiring complicated or repeated surgery: Patients who have undergone previous unsuccessful strabismus surgeries or have complex eye conditions may be recommended for surgery to correct their strabismus.

  4. Patients undergoing bilateral eye procedures: Patients who require surgery on both eyes to correct their strabismus may be recommended for surgery.

  5. Cooperative patients: Patients who are able to cooperate during the surgical procedure, such as those undergoing minimally invasive surgery or adjustable suture surgery with topical anesthesia, may be recommended for surgery.

Overall, the decision to undergo strabismus surgery is based on the individual patient’s specific condition and the recommendation of their ophthalmologist.

Timeline

Before strabismus surgery:

  1. Patient consultation: The patient meets with an ophthalmologist to discuss the strabismus condition, treatment options, and potential risks and benefits of surgery.
  2. Preoperative evaluation: The patient undergoes a comprehensive eye examination to assess the degree of strabismus, visual acuity, and overall eye health.
  3. Preoperative instructions: The patient receives instructions on fasting before surgery, medication adjustments, and any other preparations needed for the procedure.
  4. Anaesthesia consultation: Depending on the type of anaesthesia planned for the surgery, the patient may meet with an anaesthesiologist to discuss the options and address any concerns.

After strabismus surgery:

  1. Recovery room: After the surgery is completed, the patient is taken to a recovery room to monitor vital signs and ensure stability before discharge.
  2. Postoperative care: The patient may receive instructions on eye care, medication use, and follow-up appointments to monitor the healing process.
  3. Follow-up visits: The patient will have several follow-up visits with the ophthalmologist to assess the success of the surgery, address any complications, and make any necessary adjustments.
  4. Rehabilitation: In some cases, the patient may need vision therapy or eye exercises to help improve eye coordination and alignment after surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications of strabismus surgery?
  2. What is the success rate of strabismus surgery in correcting misalignment of the eyes?
  3. How long is the recovery period after strabismus surgery?
  4. Will I need to wear an eye patch or use eye drops after the surgery?
  5. How many surgeries may be needed to achieve the desired results?
  6. Will I need to follow a specific post-operative care regimen or attend follow-up appointments?
  7. What type of anesthesia will be used during the surgery?
  8. Are there any alternatives to surgery that could be considered for treating strabismus?
  9. What are the potential long-term effects of strabismus surgery?
  10. How experienced is the surgeon in performing strabismus surgery, and what is their success rate?

Reference

Authors: Chua AW, Chua MJ, Leung H, Kam PC. Journal: Anaesth Intensive Care. 2020 Jul;48(4):277-288. doi: 10.1177/0310057X20937710. Epub 2020 Aug 10. PMID: 32777929