Advanced Techniques in Strabismus Surgery: A Comprehensive Guide

Introduction

Strabismus, commonly known as squint or crossed eyes, is a condition that affects the alignment of the eyes, leading to functional and/or potential social challenges. Fortunately, advances in ophthalmology have introduced various surgical techniques to correct strabismus, offering improved outcomes and enhanced quality of life for patients.

In this blog, we will explore three strabismus surgery techniques: muscle recession, muscle plication, and adjustable suture surgery.

We will delve into the details of each technique, highlight their benefits, and address common questions and comparisons to help you gain a better understanding.

Advanced Techniques

1.  Muscle Recession (Weakening Technique):

Muscle recession, also known as weakening surgery, involves repositioning the affected eye muscles to reduce their strength, thereby restoring the alignment of the eyes. During the procedure, the surgeon detaches the muscle from its original insertion point and reattaches it farther back on the eye. This effectively weakens the muscle’s pull and allows for improved alignment.



An eye muscle which is being recessed (weakened).

Benefits of Muscle Recession surgery:

  • Corrects misalignment by reducing the strength of the overactive muscle.
  • Provides flexibility in adjusting the amount of recession based on individual needs.
  • Can be performed on any eye muscle, depending on the specific strabismus diagnosis.

2.  Muscle Plication (Strengthening Technique):

Muscle plication, also referred to as strengthening surgery, involves folding or overlapping the affected eye muscle to increase its strength. This technique is primarily used to correct underacting muscles that are unable to move the eye effectively.

Procedure:

During muscle plication surgery, the surgeon makes an incision on the muscle and folds or overlaps it, effectively shortening its length. By increasing the muscle’s mechanical advantage, the alignment of the eyes can be improved.

An example of a plicated (folded) eye muscle on a model eye.

Benefits:

  • Corrects misalignment by enhancing the strength of the muscle.
  • Allows for targeted strengthening of specific eye muscles.
  • Offers predictable and stable long-term results.
  • Safer than muscle resection surgery, due to no risk of slipped muscle and no disruption of blood flow as the muscle is not detached from the eye.

3.  Adjustable Suture Surgery:

Adjustable suture surgery is an innovative technique that offers enhanced precision and customisation in strabismus correction. It involves the use of temporary suture knots that allow for postoperative adjustments in order to fine-tune the alignment of the eyes.

Procedure:

During adjustable suture surgery, the surgeon uses dissolvable or removable sutures to temporarily secure the eye muscles. This temporary nature of the suture knots enables the ophthalmologist to make precise adjustments to the eye alignment in the immediate postoperative period, usually in the first 24 – 48 hours.

Benefits:

  • Provides the ability to fine-tune eye alignment after surgery for optimal results.
  • Reduces the need for additional surgeries by allowing adjustments during the healing process.
  • Particularly beneficial for complex cases of eye misalignment, and where previous surgery has been performed (less predictable results).

Comparing the Techniques:

While all three techniques—muscle recession, muscle plication, and adjustable suture surgery—are effective in correcting strabismus, they differ in their approach and application.

Here’s a brief comparison:

Muscle Recession:

  • Weakens eye muscles.
  • Provides flexibility in adjusting the amount of recession.
  • Can be performed on any eye muscle.

Muscle Plication:

  • Strengthens eye muscles.
  • Allows targeted strengthening of specific muscles.
  • Offers predictable and stable long-term results.

Adjustable Suture Surgery:

  • Enables postoperative adjustments for precise alignment.
  • Reduces the need for additional surgeries.
  • Particularly beneficial for complex cases or patients with unpredictable eye muscle response.
  • Suitable for a wide range of strabismus types.

It is important to remember that the choice of technique depends on the specific characteristics of your strabismus and the professional judgement of your ophthalmologist. They will carefully evaluate your case and recommend the most appropriate strabismus surgery approach for optimal results.

Conclusion:

Strabismus surgery has evolved significantly, offering advanced techniques that provide improved outcomes and enhanced quality of life for patients. Muscle recession, muscle plication, and adjustable suture surgery are all useful options for correcting strabismus and restoring proper eye alignment. By understanding the details, benefits, and comparisons of these techniques, you can have informed discussions with your ophthalmologist and make confident decisions about your treatment.

If you have any concerns or questions about strabismus surgery or any other eye-related matters, we encourage you to schedule a consultation with an experienced ophthalmologist at Clarity Eye Surgeons. Remember, early intervention and treatment can significantly improve the outcomes of strabismus correction, allowing you to enjoy clear and aligned vision.

At Clarity Eye Surgeons, we are dedicated to providing personalised and comprehensive care for all your ophthalmic needs. Contact us to schedule an appointment.

Author Bio

Dr Parth Shah is a director and principal ophthalmologist at Clarity Eye Surgeons in Canberra, specialising in strabismus surgery and cataract surgery. With extensive training and experience, he is renowned for his expertise in the field. Dr Shah is dedicated not only to performing successful surgeries but also to patient education. His compassionate approach, combined with technical proficiency, has earned him the trust and gratitude of countless patients. He is a true advocate for eye health and a trusted name in the Canberra ophthalmology community.

FAQs

Although strabismus surgery is generally safe, potential risks include overcorrection or undercorrection of the misalignment, double vision (transient or long-term), infection, retinal injury and loss of vision. 

Recovery time varies, but most patients can return to normal activities within 1-2 weeks. Complete healing may take several months.

Many patients still need glasses after surgery to correct any residual refractive errors or to help maintain proper alignment (e.g. with small amount of prism). 

Yes, strabismus surgery can be successfully performed on adults to improve eye alignment and alleviate related symptoms.

The surgery is typically performed under general anaesthesia, so patients do not feel pain during the procedure. Postoperative discomfort is usually mild and manageable with drops and analgesic tablets.

Signs that may indicate the need for a second surgery include persistent misalignment, double vision, or significant regression after the first surgery.

Strabismus surgery can improve depth perception in some cases, but results vary depending on the severity and duration of the condition.

Non-surgical options for strabismus may be suitable in some patients and include eye exercises, corrective glasses, and prisms.

Strabismus surgery can help correct double vision by realigning the eyes, but outcomes depend on the underlying cause and individual patient factors.

Postoperative follow-up includes regular check-ups to monitor healing, assess alignment, and make any necessary adjustments or recommendations for further treatment.

Injections of botulinum toxin type can weaken an overactive eye muscle. This treatment may be used with — or in place of — surgery depending on your individual case. 

In most cases, eye muscle surgery is a successful, safe, and effective treatment for strabismus in patients of all ages. 

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