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PubMedDate not supplied

Anesthetic techniques and postoperative emesis in pediatric strabismus surgery.

BACKGROUND AND OBJECTIVES: Postoperative emesis after pediatric strabismus surgery continues to be a problem, despite the use of antiemetics. The purpose of this study was to identify an anesthetic technique associated with the lowest incidence of vomiting after pediatric strabismus surgery. METHODS: A prospective, randomized, double-blind study was conducted to evaluate the effect of intravenous fentanyl, meperidine, or peribulbar block with propofol infusion on emesis in 105 pediatric patients undergoing strabismus surgery. Anesthesia was maintained with nitrous oxide, oxygen, and propofol infusion. Ketorolac 1.0 mg/kg -1 intramuscular was administered to all patients after induction. Patients were given either a peribulbar block, intravenous fentanyl 2 microg/kg -1 , or intravenous meperidine 1mg/kg -1 for perioperative analgesia. The emesis scores were observed for the first 24 hours postoperatively. RESULTS: The incidence of emesis was significantly lower (1 of 35; 2.9%) in the peribulbar group compared with the meperidine group (9 of 35; 25.6%) (P <.01) in the first 24 hours. The fentanyl group had a higher incidence of postoperative vomiting (4 of 35; 11.4%) than did the peribulbar group; the difference, however, was not statistically significant. CONCLUSION: Among the three techniques, peribulbar block with propofol-based anesthesia is the technique with the lowest incidence of postoperative emesis. Fentanyl-propofol is an equally acceptable alternative; however, meperidine-propofol is associated with a high incidence of postoperative emesis.

Anesthesia↗

PubMed2003

Adult strabismus surgery under propofol sedation with local versus general anesthesia.

PURPOSE: To compare operating room and hospital discharge times between adult strabismus surgeries using intravenous propofol sedation with local anesthesia versus those using general anesthesia. METHODS: Thirty adult patients underwent uncomplicated strabismus procedures performed by one surgeon using propofol sedation and local subtenon's anesthesia. These were retrospectively matched with adult patients undergoing similar procedures by another surgeon using general inhalational anesthesia. Only one muscle had undergone previous surgery, and no adjustable sutures were used. Times from incision closure to leaving the operating room (Out OR time), and to hospital discharge (DC time) are compared. RESULTS: Propofol/local Out OR times ranged 2 to 8 minutes (mean, 4.8). General anesthesia Out OR times ranged from 3 to 28 minutes (mean, 8.8) (means differ at P<.001). At 10 minutes, 100% of propofol patients left the OR, but only 63% of general patients had done so (P<.001). Propofol/local DC times ranged from 30 to 140 minutes (mean, 64.8). General DC times ranged from 68 to 325 minutes (mean 116.5) (means differ at P<.001). At 60 minutes after completion of surgery, 53% of propofol/local patients had left the hospital, whereas none of general patients had left (P<.001). At 2.5 hours after surgery, 100% of propofol/local patients had left the hospital, but 10% of general patients remained, with two staying more than 5 hours. CONCLUSIONS: Many adult strabismus surgeries may be performed more efficiently with intravenous propofol sedation and local subtenon's anesthesia than with general anesthesia. Times from the end of surgery to leaving both the OR and the hospital are decreased compared with those of general anesthesia. Extreme delays are rare with propofol/local, but they occurred with general anesthesia.

Adult↗

PubMed2001

Correction of cyclovertical strabismus induced by limited macular translocation in a case of age-related macular degeneration.

PURPOSE: To report a case of strabismus surgery performed to treat cyclovertical strabismus induced by limited macular translocation. METHODS: Case report. RESULTS: A 62-year-old man suffering with age-related macular degeneration and subfoveal choroidal neovascularization, RE, underwent limited macular translocation surgery. The fovea was rotated downward, and his visual acuity improved from 20/100 to 20/25 postoperatively. Cyclovertical diplopia persisted for 6 months after the operation. A Hess screen test revealed a pattern that simulated an underaction of the superior oblique muscle and inferior rectus muscle with an overaction of the ipsilateral inferior oblique muscle. To treat the diplopia, advancement of the superior oblique muscle tendon and resection of the ipsilateral inferior rectus muscle were performed. Binocular single vision with 140 seconds of arc for stereopsis was obtained. CONCLUSION: Cyclovertical strabismus after limited macular translocation is corrective with conventional surgery on the treated eye.

Choroidal Neovascularization↗

PubMed2000

Adjustment of sutures 8 hours vs 24 hours after strabismus surgery.

PURPOSE: To compare the postoperative results of adjustable-suture strabismus surgery when suture adjustment was performed 8 hours (group 1) and 24 hours (group 2) after surgery. METHODS: A retrospective clinical study was conducted in two hospitals. Strabismus surgery and muscle adjustment were performed in 90 patients. All patients had horizontal strabismus (40 patients had esotropia and 50 patients had exotropia), and they underwent either primary surgery or reoperation. Mean age of the patients was 29.9 +/- 14.1 (range, 14 to 74) years. The angle of deviation was measured in all patients before surgery, after surgery both before and after adjustment, and at the final follow-up examination. The follow-up period was 6 to 40 months (mean, 19.6 months). RESULTS: Preoperative data were similar in the two groups. The mean angle of deviation immediately after muscle adjustment was 0.6 +/- 6. 1 prism diopters in group 1 and 0.4 +/- 6.3 prism diopters in group 2. This similar deviation in the two groups (P =.9) changed during the follow-up period, and at the final examination the measured angles in groups 1 and 2 were -1.0 +/- 7.9 and -2.5 +/- 10.3 prism diopters, respectively (P =.48). The most considerable outcome measure was the calculated drift values. At the last follow-up these values were -1.6 +/- 5.8 for group 1 and -2.9 +/- 11 prism diopters for group 2 (P =.5). Subdividing the patients on the basis of their deviation before surgery, a postoperative drift toward exotropia was found in most patients of group 1. In group 2, however, a greater tendency toward exotropia was shown only by those patients who had displayed exotropia preoperatively, whereas patients with preoperative esotropia showed a greater tendency toward esotropia after surgery. CONCLUSION: In patients undergoing horizontal extraocular muscle surgery with adjustable sutures, suture adjustment 8 hours or 24 hours after surgery did not produce significantly different results.

Adolescent↗

PubMed2003

Ondansetron for the prevention and treatment of nausea and vomiting following pediatric strabismus surgery.

BACKGROUND: Neither droperidol nor ondansetron has been proven completely effective, and there are conflicting data comparing the efficacy of the two agents. The purpose of this study was to compare the efficacy, safety and cost of a combination of ondansetron administered intravenously in the operating room followed by oral ondansetron treatment at home with the more commonly used treatment of intravenous droperidol therapy and oral dimenhydrinate therapy, for the prevention and treatment of postoperative nausea and vomiting in children undergoing strabismus surgery. METHODS: Double-blind randomized clinical trial with parallel comparison groups. All patients aged 6 months to 18 years who underwent strabismus surgery at a pediatric hospital in Montreal between Nov. 13, 2000, and June 12, 2001, were included. The exclusion criteria were nausea or vomiting, or use of antiemetics or narcotics in the 24 hours preceding surgery, and past history of hepatic, gastric or renal disease. The outcome measures were frequency of nausea and vomiting, severity of nausea and adverse effects in hospital, during transportation home and during the first 24 hours at home. Data were obtained through nursing notes and through a telephone interview conducted 24 to 48 hours after discharge. RESULTS: Of the 208 eligible patients, 172 were randomly assigned to the study groups (88 to the ondansetron group and 84 to the droperidol/dimenhydrinate group). We found no statistically significant difference in the incidence of nausea and vomiting in hospital or at home between the two groups (25.3% vs. 31.6%, p = 0.371). There was a significant difference between the two groups in the rate of vomiting during transportation home (3.6% vs. 12.6%, p = 0.044). The incidence of severe nausea was 14.4% with ondansetron and 15.4% with droperidol, a nonsignificant difference (p = 1.00). No significant difference was observed between the two groups in the incidence of any nausea (p = 0.434) or adverse effects (p = 0.220). We calculated that the combination of droperidol and dimenhydrinate was seven times less costly than the ondansetron regimen. INTERPRETATION: In this study, the efficacy and safety of intravenous administration of droperidol followed by oral use of dimenhydrinate did not differ from that of intravenous followed by oral use of ondansetron in children undergoing strabismus surgery. Since treatment with ondansetron is much more costly than the combination of droperidol and dimenhydrinate, at this time the use of ondansetron in the prevention and treatment of vomiting and nausea in this population may not be beneficial on a cost basis if all other variables are considered.

Administration, Oral↗

PubMed2003

Presbyopia complicating pre-existing strabismus.

BACKGROUND: Presbyopia may affect pre-existing sensory adaptations or aggravate previously asymptomatic heterophoria. We describe the presentation, underlying problem and management of 11 patients with pre-existing strabismus or heterophoria who presented with new symptoms of double vision attributable to presbyopic change, an association not previously reported. METHODS: Patients with new strabismic symptoms attributable to presbyopia were recruited prospectively over a 1-year period. RESULTS: The 11 patients had had a recent decrease of accommodative amplitude that resulted in blurred vision at near with a breakdown of pre-existing heterophoria (2 patients), alteration of fixation pattern (6 patients), symptomatic alternating fixation (2 patients) or intolerance to correction owing to restrictive strabismus (1 patient). INTERPRETATION: At the onset of presbyopia, symptoms may be varied and subtle. Ophthalmologists and orthoptists should carefully determine the exact nature of the symptoms. Any pre-existing fixation pattern should then be established from the history, old photographs or suppression characteristics. Refractive or surgical management should be aimed at returning the patient to his or her long-standing sensory adaptation. Other important issues, such as incomplete correction of hypermetropia by refractive surgery and problems using bifocals with vertical restrictive strabismus, should be noted.

Accommodation, Ocular↗

PubMedDate not supplied

Preoperative factors influencing effectiveness of surgery in adult strabismus.

To identify preoperative factors which influence the effectiveness of strabismus surgery in adults, we retrospectively reviewed the records of 179 patients > 15 years old (131 with exotropia, 48 with esotropia) who had had combined recession and resection surgery for correction of horizontal strabismus. Eighteen preoperative variables were evaluated; those with significant influence on the surgical outcome, measured by the degree of change in deviation per millimeter of surgery, were identified by stepwise regression analysis. In patients with exotropia, preoperative distance deviation and average spherical equivalent were significant predictors of outcome at both 1 month (multiple R, 0.37) and 6 months (0.63) after surgery. In esotropic patients, significant variables at 1 month (multiple R, 0.57) and 6 months (0.77) were preoperative distance deviation and dissociated vertical deviation (DVD). Preoperative distance deviation is the common significant influence on surgical effectiveness for horizontal strabismus in adults, for both exotropia and esotropia. Additional significant predictors are average spherical equivalents in exotropic patients, and DVD in esotropic patients.

Adolescent↗

PubMed2003

Management of strabismus in nanophthalmic patients: a long-term follow-up report.

PURPOSE: The purpose of this study is to identify the characteristics of strabismus that coexist with nanophthalmos and to report the results of strabismus surgery performed on these small eyes. DESIGN: Retrospective, consecutive, noncomparative interventional case series. PARTICIPANTS: Fifteen bilateral nanophthalmic patients, of whom five underwent horizontal muscle surgery, were included in this study. METHODS: Chart review. The clinical examination included visual acuity assessments using the linear Snellen and the Lea charts, slit-lamp and fundus examinations, intraocular pressure, and axial length measurements. The orthoptic examination consisted of measurements of ocular deviations using the prism cover test with an accommodative target at both near and distance with and without refractive correction, assessment of ocular motility with ductions and versions, binocularity with Worth's four-dot test, and the Titmus test. Amblyopia was treated with part-time occlusion. Surgery for the correction of esotropia included bilateral medial rectus recessions or recess-resect procedures. MAIN OUTCOME MEASURES: Magnitude of strabismic deviation, best-corrected visual acuity, and the level of binocular vision achieved were monitored. RESULTS: The average age of enrollment in the study was 4.7 (range, 1-12) years. The patients were followed for an average of 7.0 (range, 4-14) years. The mean axial length was determined as 18.4 mm (range, 15.5-20.7). The mean refractive error in spherical equivalents was measured as +9.9 and ranged between +4.0 and +15.0 diopters. Five patients (33%) had nonaccommodative esotropia, four (27%) had partially refractive esotropia, four (27%) had microesotropia, and two (13%) had exotropia. Five patients, all having nonaccommodative esotropia, underwent surgery for the correction of ocular misalignment. Diminishing the surgical dose in these small eyes resulted in undercorrections. Despite patching, 3 patients (20%) had unilateral and 12 patients (80%) had bilateral amblyopia at the conclusion of the study. CONCLUSIONS: Strabismus in nanophthalmos usually manifests as nonaccommodative and partially refractive esotropia. Medial rectus recession should be applied with care to prevent adduction deficit and convergence insufficiency. Otherwise, there seems to be no need for decreasing the surgical dose with regard to the smaller axial length. Amblyopia tends to be persistent in these patients.

Accommodation, Ocular↗

PubMed2003

Comparison of lidocaine 2% gel versus amethocaine as the sole anesthetic agent for strabismus surgery.

PURPOSE: To compare the efficacy of lidocaine 2% gel with amethocaine 1% eyedrops as the sole anesthetic agent for one-stage adjustable suture strabismus surgery. DESIGN: Prospective, double-masked randomized trial. PARTICIPANTS: Fourteen consecutive patients scheduled to undergo bilateral and symmetrical strabismus surgery under topical anesthesia in one institution. METHODS: Each patient was randomized to receive lidocaine 2% gel in one eye and amethocaine 1% eyedrops in the other eye as the sole anesthetic agent for surgery. Masking of the patient and surgeon was ensured by administration of a placebo gel and eyedrop as part of the regimen. Pain and discomfort were assessed via a 10-cm visual analog scale. MAIN OUTCOME MEASURES: Subjective pain and discomfort perceived during surgery were assessed separately by the patient and the surgeon, and the need for any additional anesthesia was recorded. RESULTS: A total of 14 subjects indicated mean pain and discomfort scores of 2.6 and 3.2 respectively, for lidocaine gel, and 5.3 and 6.2, respectively, for amethocaine drops (P = 0.01). The mean number of additional drops required by eyes randomized to lidocaine gel was 0.3, compared with 1.6 for amethocaine drops (P = 0.02). CONCLUSIONS: In terms of pain control, lidocaine 2% gel alone is a superior topical anesthetic for one-stage adjustable suture strabismus surgery when compared with amethocaine 1% eyedrops.

Adult↗

PubMed1991

Use of botulinum toxin in strabismus after retinal detachment surgery.

Botulinum toxin was used to treat 20 patients with strabismus after retinal detachment surgery. Preinjection motility deviations ranged from 10 to 60 prism diopters (D). Postinjection deviations ranged from 0 to 20 prism D, with 75% being 10 D or less. Eighty-five percent achieved fusion that persisted, with 73% requiring only one or two injections. Only muscles in the eye that had undergone retinal reattachment surgery were injected. The average period of follow-up was 12 months. Complications were rare and all resolved spontaneously. Botulinum toxin appears to be useful as a primary treatment modality for persistent strabismus following retinal detachment surgery, possibly obviating the need for complicated strabismus surgery.

Adolescent↗

PubMed1992

Long-term results of adjustable suture surgery for strabismus secondary to thyroid ophthalmopathy.

PURPOSE: To review the results of adjustable suture surgery in patients with strabismus secondary to thyroid ophthalmopathy to determine long-term outcome and to identify postoperative complications. METHODS: The records of 1524 patients with thyroid ophthalmopathy were retrospectively reviewed to identify those who required treatment for strabismus in the ocular motility clinic. Treatment consisted of adjustable suture surgery, prisms, or both. Elimination of diplopia in primary and reading positions was used at the criterion for success. RESULTS: Forty-seven patients were treated with adjustable suture surgery, with an average follow-up of 41 months. Results after 1 or more surgeries were: 47% excellent, 26% good, 19% fair, and 9% poor. Significant postoperative complications included eyelid retraction and A-pattern exodeviation. Sixteen of 18 patients with fair or poor outcomes after the initial surgery were recognized within 6 months. Postoperative changes in vertical deviation from primary position to downgaze were predictive of postoperative diplopia in downgaze. Analysis of multiple preoperative characteristics showed no statistically significant associations with outcome. Eight additional patients had adequate relief of diplopia using prisms alone, with an average follow-up of 49 months. CONCLUSIONS: Long-term symptomatic relief of diplopia was obtained in the majority of patients using adjustable suture strabismus surgery, combined occasionally with small amounts of prism postoperatively. Prisms alone provided effective long-term relief in patients with small-to-moderate deviations.

Fluorescein Angiography↗

PubMed1994

Ketorolac versus acetaminophen or ibuprofen in controlling postoperative pain in patients with strabismus.

PURPOSE: Ketorolac is a new, parenteral, nonsteroidal, anti-inflammatory agent. The authors compare the effectiveness of a single intravenous dose of ketorolac with a single oral dose of either acetaminophen or ibuprofen in controlling postoperative pain in patients with strabismus. METHODS: A prospective, randomized, double-masked study was performed on 60 patients older than 12 years of age who were undergoing strabismus surgery. The patients were randomized into one of three single-dosage treatment groups: group 1 received oral acetaminophen (650 mg); group 2 received oral ibuprofen (600 mg); and group 3 received intravenous ketorolac (60 mg) intraoperatively and placebo capsules postoperatively. Pain and sedation levels were assessed at 2 and 5 hours after surgery by having the patient mark a standard 100-mm visual analog scale. RESULTS: The ketorolac-treated patients had significantly less pain at both the 2- and 5-hour intervals after surgery compared with either the acetaminophen or ibuprofen groups (P = 0.001). There was no difference in the level of sedation among any of the three treatment groups. CONCLUSION: Intravenous ketorolac given at the conclusion of surgery was more effective than either oral acetaminophen or oral ibuprofen given 30 to 45 minutes after strabismus surgery in controlling postoperative pain. Pain relief was achieved earlier by intravenous delivery than by oral agents. Greater pain relief with ketorolac was sustained 5 hours after surgery. This facilitates suture adjustment and earlier discharge. Similar pain control is possible for other ophthalmologic surgery. Because the oral medications used in this study were administered in capsules, the results may have been different if clinically available preparations had been tested.

Acetaminophen↗

PubMed1996

Vertical strabismus after cataract surgery.

PURPOSE: To compare anesthesia methods with resultant strabismus patterns in patients with vertical diplopia after cataract surgery. METHODS: The authors analyzed 28 consecutive patients with acquired vertical diplopia after cataract surgery to identify the strabismus pattern. The method of anesthesia administration was available in 21 patients. Three orbital dissections with simulated retrobulbar blocks were performed on cadavers to ascertain the possibility of injuring the vertical rectus muscles at the time of injection. RESULTS: Fifty percent of the involved muscles were overactive, 39 percent were restricted, and 11 percent were paretic. Eleven patients received retrobulbar, and ten received peribulbar anesthesia. The inferior rectus in 17 patients and the superior rectus muscle in 11 were involved. The odds of damaging the inferior rectus, as opposed to the superior rectus muscle, with peribulbar anesthesia was 4.8 times higher than with retrobulbar blocks. Cadaveric dissections showed the likelihood of direct needle injury to either vertical recti with retrobulbar blocks. CONCLUSIONS: In this patient population, permanent vertical strabismus after cataract surgery results more often from overacting or restricted muscles than from primary muscle paresis. Both the superior and inferior recti can be injured with retrobulbar anesthesia, but peribulbar injections affect the inferior rectus muscle more frequently.

Anesthesia, Local↗

PubMed1997

Comparison of postoperative emesis, recovery profile, and analgesia in pediatric strabismus repair. Rectal acetaminophen versus intravenous fentanyl-droperidol.

BACKGROUND: Postoperative nausea and vomiting comprise significant morbidity in pediatric patients undergoing strabismus repair and can prolong hospitalization. Many authors recommend routine intraoperative opiate analgesia and prophylactic antiemetics. METHODS: A prospective, comparative, randomized study to assess rectal acetaminophen (n = 45) to intravenous fentanyl-droperidol (n = 45) to resolve recovery profile, emesis rate, and adequacy of analgesia in a pediatric strabismus repair population was performed, with standardization of the anesthetic technique. Data on pharmacoeconomic cost-effectiveness analysis, willingness to pay, and willingness to repeat were elucidated. RESULTS: Emesis rate in the acetaminophen group was 9%, and the fentanyl-droperidol group was 13% (not statistically significant). There was a statistically significant shorter wake-up time, time in postanesthesia recovery, time in ambulatory surgery unit, time to first verbal command, time to first oral intake, time to ambulation, and time to return to normal activity in the acetaminophen group (P < 0.05). Postoperative analgesic potency of rectal acetaminophen was adequate and equivalent by Observer Pain Scale. Parental satisfaction was similar by willingness-to-pay and willingness-to-repeat postoperative survey. Cost-effectiveness ratio (i.e., cost per treatment success) for acetaminophen and fentanyl-droperidol groups was $0.33 and $87.91, respectively. CONCLUSIONS: Prophylactic fentanyl-droperidol prolongs the length-to-stay and recovery time and provides no discrete identifiable benefit over acetaminophen alone in this population. Cost-effectiveness analysis strongly favors use of acetaminophen over fentanyl-droperidol prophylaxis in children undergoing primary strabismus surgery.

Acetaminophen↗

PubMed1999

Preoperative oral granisetron for the prevention of vomiting after strabismus surgery in children.

OBJECTIVE: To evaluate the efficacy of oral granisetron for the prevention of postoperative vomiting in children undergoing strabismus surgery. DESIGN: Prospective, randomized, double-masked, placebo-controlled study. PARTICIPANTS: A total of 120 children, 4-10 years of age, scheduled for elective strabismus surgery. INTERVENTION: Patients received oral placebo or granisetron at three different doses (20 microg/kg, 40 microg/kg, 80 microg/kg) 1 hour before surgery. MAIN OUTCOME MEASURES: A complete response, defined as no vomiting, no retching, and no need for rescue antiemetic medication, during the first 24 hours after anesthesia was recorded. RESULTS: A complete response during 0-24 hours after anesthesia occurred in 33% of those who received placebo, 40% who received granisetron 20 microg/kg, 83% who received granisetron 40 microg/kg, and 87% who received granisetron 80 microg/kg (P < 0.05, overall Fisher's exact probability test). CONCLUSION: Preoperative oral granisetron, in doses more than 40 microg/kg, is effective for preventing vomiting after strabismus surgery in children.

Administration, Oral↗

PubMed1999

Visual representation of space in congenital and acquired strabismus.

The aim of the present work was to readdress the problem of altered spatial localization in strabismic subjects and to assess whether and how spatial representation is affected by the degree of plasticity of the brain. We therefore compared targeting performance in adult subjects affected by acquired strabismus versus children affected by congenital strabismus. Our data confirm the correlation between deviation of the eye and targeting errors, but they also show that this correlation is not present when strabismus occurs early in life. We suggest that the neuronal machinery involved in the building of an internal representation of space reaches its full maturity several years after birth and that this might explain the limited differences observed in targeting errors between normal and strabismic children.

Adult↗

PubMed1996

[Does oral ondansetron reduce the incidence of nausea and vomiting after surgery for strabismus in children?].

OBJECTIVE: To compare the efficacy of oral ondansetron with oral metoclopramide for the prevention of postoperative vomiting and nausea in children undergoing strabismus surgery. STUDY DESIGN: Prospective, randomized, double-blind trial. PATIENTS: Thirty children of physical class 1, age 9 +/- 4 years, scheduled for strabismus surgery, were randomized into two groups (ondansetron and metoclopramide). METHODS: In the ondansetron group, the children received the first oral dose of ondansetron (4 mg) 1 hour before induction of anaesthesia and the other doses 8 and 16 hours later. In the metoclopramide group, children received metoclopramide (5 mg) in the same conditions. Anaesthesia was induced with thiopentone, vecuronium and fentanyl and maintained with halothane and N2O/O2. Patients were evaluated by an independent observer for nausea and emesis in recovery room (0-2 h) and on the ward. The adverse effects of oral ondansetron and metoclopramide were assessed. RESULTS: There were non-significant differences between the two groups for incidence of nausea and vomiting (40% and 53% in ondansetron group versus 33 and 60% in metoclopramide group, respectively. CONCLUSION: Unlike intravenous ondansetron, oral ondansetron is not superior to metoclopramide for the prevention of nausea and vomiting caused by strabismus surgery in children.

Administration, Oral↗

PubMed1986

Combined intraocular lens and strabismus surgery.

Ten cases of combined strabismus surgery and intraocular lens implantation were reviewed to determine if there were increased risks and complications. A review of these cases revealed the contrary was true; i.e., there were no complications arising from the combined surgery and there were benefits in the decreased hospitalization and operative time, less mental trauma, and improved muscle surgical outcome. From these results, we conclude that combined intraocular lens and strabismus surgery is efficacious and indicated in patients with strabismus and cataracts or aphakia.

Combined Modality Therapy↗