Pediatric and Adult Strabismus Surgery

Pediatric and Adult Strabismus Surgery

Strabismus surgery is the most commonly performed ophthalmic procedure in children. This type of surgery is also performed on adults with new or previously existing ocular misalignment. Recession and resection procedures are typically performed for horizontal misalignment (esotropia and exotropia); other approaches include tuck, loop myopexy and transposition procedures for horizontal, vertical and torsional forms of misalignment. Adjustable sutures are used routinely in children and adults. The service has a high rate of quaternary referrals from other pediatric and strabismus specialists to manage the rarest and most complex cases, with nearly half of all patients treated having undergone prior strabismus surgery.

Distribution of Strabismus Patients by Age and Surgical Approach

The Strabismus Service at Boston Children’s Hospital offers comprehensive evaluation and treatment for children and adults with strabismus. In 2023, 807 total strabismus procedures were performed at Boston Children’s Hospital, Massachusetts Eye and Ear, the University of Massachusetts, and other Harvard affiliates. These procedures addressed misalignments that were horizontal, vertical, and torsional in nature.

Distribution of Risk Factors in Strabismus Patients

Of the 807 total strabismus surgeries performed in 2023, 393 patients presented with risk factors associated with a worse surgical outcome. Of these 393 patients with risk factors, the most common risk factors were a history of prior strabismus surgery (46.6%), divergence insufficiency (8.4%), and 4th nerve palsy (7.1%). Other common risk factors were 6th nerve palsy, cerebral palsy, Duane syndrome, heavy eye syndrome, 3rd nerve palsy, developmental delays, premature birth, craniofacial disorders, high myopia, brain tumor, Down Syndrome, and nystagmus.

Goal-Determined Outcomes

Since the desired surgical outcome depends on the primary indication for surgery, we used a goal-determined methodology to assess outcomes of horizontal strabismus surgery.^1,2 The reported outcomes include procedures performed by ophthalmologists with joint appointments at Boston Children’s Hospital and the Mass Eye and Ear Pediatric Ophthalmology and Strabismus Service. Procedures performed by the Mass Eye and Ear Adult Neuro-Ophthalmology service are not included in this analysis.

Before and After Horizontal Strabismus Surgery