Title: Changes in Refractive Status after Strabismus Surgery- A Clinical Study

Authors: Dr Accamma Mamman, Dr Saji Nair A

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i5.121

Abstract

Aim: To analyse the changes in the refractive status occurring in the eyes after strabismus surgery.

Materials and Methods: An analytical study was conducted in 90 patients who underwent strabismus surgery for concomitant horizontal strabismus. The patients were divided into two groups of 45 each. Group 1 comprises of patients with concomitant exotropia and Group 2 patients with concomitant esotropia.   Pre operative cycloplegic refraction was done and post operative cycloplegic refraction was done at one week, four week, three month and six months post operatively. Pre and post operative refraction was compared in terms of spherical equivalent and cylindrical power.

Results: The spherical equivalent showed   a change to myopic trend in both the groups which was maximum in the first post operative week. The changes were persisting at 12 weeks post operatively in both the groups, having stabilized by about four to six weeks. The difference from preoperative values were not statistically significant in both the groups. Astigmatism also showed a myopic trend post operatively.  The mean change in the meridional equivalent at 180 degree was statistically significant in both the groups. The mean change in the meridional equivalent at 90 degree was not statistically significant in both the cases. The changes in the refractive status occurring when two muscles are encountered in the same eye showed more change in refractive status than when only one muscle was encountered and was also statistically analysed using paired t test and was found to be significant.

Conclusion: Strabismus surgery changes the refractive status post-operatively. Hence appropriate prescription of glasses is important following strabismus surgery especially in children to prevent amblyopia and to maintain stable fusion.

Key Words:  Strabismus , Spherical equivalent, Astigmatism, Corneal topography, Refractive error

References

1.      Don Marshall M: Arch Ophthalmol 1936;15(6):1020-1031 .   

2.      Thompson WE, Reinecke RD.  The changes in refractive status following routine strabismus surgery. J Pediatr Ophthalmol Strabismus.1980 Nov-Dec;17(6):372-4.                           

3.      Preslan M ,Cloffi G , Min Y . Refractive error changes following strabismus surgery. J Pediatric  Ophthalmol  Strabismus 1992;29:300-4.

4.      Dr Kamlesh , Dr Shailley Jain , Professor of Ophthalmology , Guru Nayak Eye Centre ,  New Delhi. Changes in refractive status following strabismus surgery.

5.      Daphna Mezad – Koursh , Ari Leshno , Tomer Ziv- Baran and ChaimStolovitch.                                                        Journal of  Ophthalmology ;Volume 2017 (2017 ).

6.      C.F.Gomi; I.Debert;F.A.Medeiros; M.P olati; D.B.Granet.  Investigative Ophthalmology & Visual Science, May 2008, Vol.49, 1125. Doi

7.      A. Bagheri, A. Farahi, and D. L. Guyton.  Astigmatism induced by simultaneous recession of both horizontal rectus muscles.  Journal of AAPOS, vol. 7, no. 1, pp. 42–46, 2003. 

8.      Snir M , Nissenkorn I ,Buckman G et al . Postoperative refraction changes in children with congenital esotropia .  Ophthalmic Sur 1989 ; 20: 57-62.

9.      D.P. Hainsworth, J. R. Bierly, E. T. Schmeisser, and R. S. Baker. Corneal topographic changes after extraocular muscle surgery.  Journal of AAPOS 1999, vol. 3, no. 2, pp. 80–86.

10.  Kwitko S ,Sawusch MR , MC Donnell  P J et al . Effect of extraocular muscle surgery on corneal topography. Arch Ophthalmol 1991;109:873-8.

11.  Fix A, Baker JD. Refractive changes following strabismus surgery.  American Orthoptic Journal 1985;35:59-62

12.  Loupe DN , Michles RG et al. Refractive changes after sclera buckling surgery. Arch Ophthalmol 1988;107 :1469-71 . 

13.  H. D. Schworm, S. Ullrich, C. Höing, C. Dittus, and K.-P. Boergen, “Does strabi-smus surgery induce significant changes of corneal topography?” Strabismus 1997; vol. 5, no. 2,  pp. 81–89.

14.  Nardi M ,Rizzo S, Prellegrini G , Effects of strabismus surgery on corneal topography. J Pediatric Ophthalmol Strabismus 1997;34:244-6 .

15.  Z. Rajavi, H. M. Rabei, A. Ramezani, A. Heidari, and F. Daneshvar, “Refractive effect of the horizontal rectus muscle recession.  International Ophthalmology 2008, vol. 28, no.2,  pp. 83–88.

Corresponding Author

Dr Accamma Mamman

Regional Institute of Ophthalmology, Govt  Medical  College,

Thiruvananthapuram- 695035, Kerala, INDIA

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.