Cole Eye Institute - Cleveland Clinic

Surgical Outcome for Adults
N=151
19% Poor (Overcorrected
or undercorrected)
Surgical Outcome for Children
N=97
6% Poor (Overcorrected
or undercorrected)
Surgical Outcome for Adults
Surgical Outcome for Children
81% Good (Diplopia disappeared
and/or anomalous head
position resolved)
94% Good (Deviation < 10 prism
diopters in primary position
and/or anomalous head
position resolved)
A total of 271 strabismus surgeries were performed from January 2006 through December 2007. Of these, 109 surgeries were on adults (16 years and
older) and 162 surgeries were on children under the age of 16. A total of 90 surgeries were for esotropia, 100 for exotropia, 25 for thyroid eye disease,
28 for IVth nerve palsy, 4 for VIth nerve palsy, 13 for dissociated deviations, 9 for hypertropia and 2 for nystagmus. Outcomes were assessed at the latest
follow-up exams, which ranged from 1 day to 1 year postoperatively. Outcomes were considered good if constant deviations were < 10 prism diopters in
primary position in children and in adults without diplopia, if diplopia disappeared in adults, and if an anomalous head position resolved.
A total of 17 adults and 73 children had esotropia. Outcomes were good in 14 adults and in 68 children. Poor results occurred in 1 adult and 2 children.
All 3 were initially undercorrected. Two of the 3 were reoperated with good outcomes. No follow-up data were available on 2 adults and 3 children. A total
of 45 adults and 55 children were operated on for exotropia. Results were good in 35 adults and 47 children, whereas results were poor in 8 adults and
2 children. The 2 children were undercorrected; 1 was reoperated with a good outcome. Six adults were undercorrected and 2 were overcorrected. Three
of the undercorrected adults previously had scleral buckles, 1 had a torn muscle and 1 had bilateral internuclear ophthalmoplegia. Follow-up was not
available for 2 adults and 5 children.
Surgery was done for IVth nerve palsy on 12 adults and 16 children. Hypertropia or head tilt resolved in 9 adults and 13 children, but were poor in 1
adult and 2 children who were undercorrected. Both children were reoperated; one had a good outcome after a second procedure and the other had a
good outcome after a third procedure. No follow-up was available in 2 adults and 1 child. VIth nerve palsy was addressed in 1 child and 2 adults. The
child had 2 procedures; the first result was poor and the second one was good. One adult had a good outcome and 1 did not return for follow-up.
Twenty-five procedures were done for thyroid eye disease on 20 adult patients. One patient had a good result after 3 procedures; another had a good
result after 2. They had initially been undercorrected. Eleven patients had diplopia resolved after the initial surgery. Of the 6 remaining with a poor
outcome, all were undercorrected except one who was overcorrected. Outcome could not be assessed in 1 patient who did not return for follow-up. Five
adults and 4 children had a vertical deviation, or hypertropia. One adult needed 2 procedures to achieve a good outcome. Two of the 5 adults had a
poor outcome due to being undercorrected. One of these adults previously had an orbital fracture, and the other one had AMD and a retinal detachment
repaired 3 of the 4 children had a good outcome. The 1 poor outcome resulted in an undercorrection. One did not return for follow-up.
Two children were operated on for an abnormal head posture due to nystagmus. Both had a good result.
25 Cole Eye Institute