Late Surgical Correction of Longstanding Constant Strabismus in Adults: Is Fusion Possible in All Successfully Aligned Patients?

J Binocul Vis Ocul Motil. 2020 Jul-Sep;70(3):109-114. doi: 10.1080/2576117X.2020.1787017. Epub 2020 Jul 16.

Abstract

Purpose: To determine whether late surgical correction provides fusion in adults who have constant strabismus beginning in early childhood.

Materials and methods: This was a prospective study that included 34 consecutive adults with a history of early onset strabismus who had not previously undergone surgery. They were tested with the Bagolini striated glasses (BSG), Worth four-dot (W4D) test, cover test, and four-prism diopter (4-PD) test, preoperatively, and 6 weeks after surgery.

Results: The mean age was 23.8 years, 17 patients had esotropia and 17 patients had exotropia. Preoperatively, all patients demonstrated a manifest horizontal deviation ranging from 30 to 60 and had suppression. At 6 weeks postoperatively, 33 patients had a horizontal manifest deviation of <15 (range, 2-14; median, 6), and none were orthotropic as determined by the cover test together with the 4-PD test. All of these 33 patients achieved anomalous retinal correspondence (ARC) with the BSG at near, and 25 (75%) had ARC with the W4D test at near.

Conclusions: Although our study has limited number of patients its findings suggest it is possible to develop ARC after surgery in almost all adult patients with childhood-onset strabismus associated with suppression, and who have not previously been operated upon, if satisfactory alignment is achieved in adulthood.

Keywords: Adult strabismus surgery; anomalous retinal correspondence; bagolini striated glasses; binocular vision; fusion.

MeSH terms

  • Adult
  • Depth Perception / physiology
  • Eye Movements / physiology
  • Female
  • Humans
  • Male
  • Oculomotor Muscles / surgery*
  • Ophthalmologic Surgical Procedures*
  • Prospective Studies
  • Retina / physiology*
  • Strabismus / physiopathology
  • Strabismus / surgery*
  • Vision, Binocular / physiology*
  • Visual Acuity / physiology
  • Young Adult