Strabismus surgery only after amblyopia has been fully treated.

1. Strabismus ResurgeryStrabismus Resurgery
mademade SimpleSimple
Dr. Madhu KarnaDr. Madhu Karna
StrabismologistStrabismologist

2. After first surgeryAfter first surgery

3. 6 months Postop turns into6 months Postop turns into
Consecutive exotropiaConsecutive exotropia
realigned after Resurgeryrealigned after Resurgery

4. TipTip
Risk factors for overcorrection- A pattern,Risk factors for overcorrection- A pattern,
amblyopia, high hyperopia.amblyopia, high hyperopia.
Risk factors for undercorrection –amblyopia.Risk factors for undercorrection –amblyopia.
**Strabismus surgery only after amblyopiaStrabismus surgery only after amblyopia
has been fully treatedhas been fully treated..

5. Right eye third nerve palsy afterRight eye third nerve palsy after
two squint surgeriestwo squint surgeries

6. Using props on the glasses to liftUsing props on the glasses to lift
the lid after alignment fromthe lid after alignment from
previous surgeriesprevious surgeries

7. Residual exotropia or progession ofResidual exotropia or progession of
palsy - Reinvestigatepalsy - Reinvestigate

8. Meningioma posterior clinoidMeningioma posterior clinoid

9. TrickTrick

First surgery resultFirst surgery result

Progressive problemProgressive problem

Unmasking of other components -Unmasking of other components -
Reoperations inevitableReoperations inevitable

11. Operated infantile esotropiaOperated infantile esotropia
presenting with DVDpresenting with DVD

12. PostopPostop

14. When to reoperateWhen to reoperate
At least 2 months after the initial surgeryAt least 2 months after the initial surgery
except:except:
 Lost or slipped muscleLost or slipped muscle
 Large overcorrection after an SO tuckLarge overcorrection after an SO tuck
 Large vertical deviations induced byLarge vertical deviations induced by
muscle transposition proceduresmuscle transposition procedures

15. This squint may trap you byThis squint may trap you by
seeming simple butseeming simple but
HYPEROPIA WITH EXOTROPIAHYPEROPIA WITH EXOTROPIA

16. Before you operateBefore you operate
this patientthis patient
Just remove theJust remove the
glassesglasses

17. Esotropia without glasses !!Esotropia without glasses !!

19.  High hyperopia with AccomodativeHigh hyperopia with Accomodative
Esotropia with Consecutive ExotropiaEsotropia with Consecutive Exotropia
 Reduce hyperopic power by halfReduce hyperopic power by half
 If exotropia still manifest or there is a dropIf exotropia still manifest or there is a drop
in visual acuity then operate on thein visual acuity then operate on the
consecutive Exotropia after measuringconsecutive Exotropia after measuring
over maximum cyclopegic refraction.over maximum cyclopegic refraction.

20. Conservative Vs AggressiveConservative Vs Aggressive
 Sensory strabismus mainly sensorySensory strabismus mainly sensory
exotropiaexotropia
 Do FDTDo FDT
 Release the restrictions and do maximumRelease the restrictions and do maximum
recess- resectrecess- resect
 Inferior Oblique and SO can be weakenedInferior Oblique and SO can be weakened
which are additional abductorswhich are additional abductors..

Raab, unilateral 4 muscle study for largeRaab, unilateral 4 muscle study for large
angle exotropia, Ophthal, 1979: 86, 1441angle exotropia, Ophthal, 1979: 86, 1441

21. Consecutive Exo operated twiceConsecutive Exo operated twice
earlierearlier

22. PostopPostop

23. END- Effort Never DiesEND- Effort Never Dies
 Reop expected in 5-10% of patients whoReop expected in 5-10% of patients who
undergo squint surgeryundergo squint surgery
 Any reop introduces a 33% probability of yetAny reop introduces a 33% probability of yet
another procedureanother procedure
 We will make 100% effort to make this the lastWe will make 100% effort to make this the last
squint surgery neededsquint surgery needed

24. We really don’t learn anything from ourWe really don’t learn anything from our
experience we only learn from reflectingexperience we only learn from reflecting
on our experience.on our experience.

25.  Strabismus surgery only after amblyopiaStrabismus surgery only after amblyopia
has been fully treatedhas been fully treated
 Progressive problemProgressive problem
 Operate on the consecutive ExotropiaOperate on the consecutive Exotropia
after measuring over maximum cyclopegicafter measuring over maximum cyclopegic
refractionrefraction
 In Sensory Exotropias Inferior ObliqueIn Sensory Exotropias Inferior Oblique
and SO can be weakened which areand SO can be weakened which are
additional abductorsadditional abductors

26. THANK YOUTHANK YOU