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ORIGINAL ARTICLE
Year : 2009  |  Volume : 57  |  Issue : 2  |  Page : 121-125

Evaluation of single-stage adjustable strabismus surgery under conscious sedation


1 Strabismology Service, Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi-110 029, India
2 Department of Anesthesia, All India Institute of Medical Sciences, New Delhi-110 029, India

Correspondence Address:
Pradeep Sharma
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.45501

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Purpose: To evaluate the feasibility and stability of ocular alignment after single-stage adjustable strabismus surgery (SSASS) performed under topical anesthesia. Materials and Methods: Forty-five patients of concomitant exodeviations were randomized into three groups of 15 cases each and were operated with three different techniques: Group I - conventional surgery, Group II - two-stage adjustable suture technique with suture adjustment performed 6h postoperatively and Group III- SSASS under topical anesthesia and intravenous conscious sedation with midazolam and fentanyl. Intraoperative suture adjustment was done by giving a cross target to the patient on the ceiling at the end of the procedure. Surgical results were compared among the three groups at three months follow-up. Intraoperative hemodynamic parameters and patients' experience of the surgery (by questionnaire) were also compared. Results: Mean preoperative deviation for distance in Groups I, II, III was -41.67 prism diopter (pd) 9.0, -38.93 pd 11.05 and -41.87 pd 8.91 ( P =0.6) respectively. At three months, mean correction achieved for distance was +31.87 pd 11.71, +35.47 pd 10.86 and +42.80 pd 10.71 respectively which was significantly different between Group III and Group I ( P =0.03). Intraoperatively all hemodynamic parameters remained stable and comparable ( P =0. 5) in all groups. Intraoperative pain ( P <0.001) and time taken for surgery ( P <0.001) was more in the SSASS group. Amount of exodrift was 10-12 pd, comparable in all three groups ( P = 0.5). Conclusions: SSASS, performed under topical anesthesia, is safe and has better outcomes than conventional recession-resection surgery for concomitant exodeviation. An overcorrection of about 10-12 pd is recommended to check the exodrift and achieve stable alignment.


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