Clinical Audit of Horizontal Strabismus Surgery in Children in Maharashtra, India

BACKGROUND: The study aimed to audit the results of horizontal strabismus surgery in the hospital's pediatric ophthalmology department in Maharashtra, India. METHOD: Medical records of strabismus surgeries done over 3 years were collated. Preoperative visual acuity, deviation, refraction, and orthoptic evaluation were noted as well as post-operative residual deviation and patient satisfaction. Post-operative residual deviation < or = 10Delta was considered good outcome, 11-20Delta borderline, and > 20Delta was considered poor outcome. The surgeons were briefed about their results periodically and the cause of poor outcomes discussed. RESULT: Between March 2004 and December 2007, 529 children were operated upon, of whom 461 (87.1%) completed the 6-week follow-up. Average age was 9 years 7 months (range 1-19 years). 260/461 (56.3%) patients had good, 100/461 (21.6%) borderline, and 101/461 (21.9%) had poor outcome. 133/231 (57.6%) cases of esotropia and 127/230 (55.2%) cases of exotropia had a good outcome, while the poor outcome was 50/231 (21.6%) and 51/230 (22.1%), respectively. Bilateral medial rectus recession for esotropia had 25/56 (44.6%) good outcome and 15/56 (26.7%) poor outcome, while recess-resect procedures (R/R) for esotropia had 108/175 (61.7%) good and 35/175 (20%) poor outcome (p = 0.062). Bilateral lateral rectus recession for exotropia had 30/56 (53.6%) good and 12/56 (21.4%) had poor outcome, while for recess-resect procedures for exotropia it was 97/174 (55.7%) good and 39/174 (22.4%) poor outcome (p = 0.97). The result did not significantly change over 3 years. 433/461 (93.9%) expressed satisfaction about the surgery on 6-week follow-up. Large pre-operative deviations and amblyopic eyes accounted for 63/101 (62.3%) cases of poor outcome. Fifty-seven patients recorded an improvement in stereopsis. CONCLUSION: Recess-resect procedures had better outcome as compared to bilateral recess procedures, but it was not statistically significant. Clinical audit helped maintain and improve good outcome over the 3 years.