Accepted Manuscript

Strabismus surgery outcomes without removal of scleral buckle in patients with

previous retinal detachment repair

Savleen Kaur, MS, Mohit Dogra, MS, Jaspreet Sukhija, MS, Mangat R. Dogra, MD

PII: S1091-8531(18)30495-6
DOI: 10.1016/j.jaapos.2018.07.344
Reference: YMPA 2885

To appear in: Journal of AAPOS

Received Date: 19 July 2018

Accepted Date: 19 July 2018

Please cite this article as: Kaur S, Dogra M, Sukhija J, Dogra MR, Strabismus surgery outcomes without
removal of scleral buckle in patients with previous retinal detachment repair, Journal of AAPOS (2018),
doi: 10.1016/j.jaapos.2018.07.344.

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 ACCEPTED MANUSCRIPT
Strabismus surgery outcomes without removal of scleral buckle in patients with
previous retinal detachment repair
Savleen Kaur, MS, Mohit Dogra, MS, Jaspreet Sukhija, MS Mangat R Dogra, MD
Author Affiliation: Advanced Eye Centre, Postgraduate Institute of Medical Education and
Research, Sector 12, Chandigarh-160012, India
Corresponding author: Mohit Dogra, Advanced Eye Center, Postgraduate Institute of Medical
Education and Research, Sector 12, Chandigarh-160012, India (email:

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mohit_dogra29@gmail.com).
Acknowledgment: Council of Scientific and Industrial Research, India

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Word count: 487 words

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Strabismus surgery outcomes without removal of scleral buckle in patients with

previous retinal detachment repair

To the Editor: Osigian and colleagues1 have concluded that despite surgical difficulties,

motor success can be achieved by strabismus surgery without removing the buckle in patients

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with prior retinal detachment (RD) repair. Strabismus surgery in the presence of a buckle

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poses many anatomical challenges. Adhesions between muscles and fibrosis coupled with

mechanical effect of the explant leads to greater chances of muscle slippage and

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unpredictable surgical results.2 We congratulate the authors on their good motor and sensory

success rate. However, the surgical technique to tackle strabismus is somewhat vague.

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Was the data retrospectively collected from electronic medical records or from
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handwritten files? This is important, because crucial details of RD surgery are lacking in the
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data provided. Type of surgery performed—vitrectomy with scleral buckle or scleral buckle

alone—are not mentioned. The extent and type of buckle used are also important factors
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affecting strabismus development and management.3,4

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It would be good to know the type and ease of conjunctival incision made, difficulty

faced in isolating/hooking of extraocular muscles, whether the buckle capsule was incised
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during the surgical procedure, and how were the muscles attached over the buckle to the
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sclera. The authors do not comment on the ocular motility of the patients, which might
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influence surgical planning.

We note that the mean time period between retinal and strabismus surgeries was

around 22 months, but the range was broad (6-63 months). It might be useful to know the

median values. Also, did the authors wait for spontaneous resolution or change in the

magnitude of diplopia in these patients for at least 6 months? Could they determine an ideal

time period after retinal surgery when strabismus correction would ensure higher chance of
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surgical success and less fibrosis?

The patients with surgery in the contralateral eye should be excluded if they were

treatment naïve surgically. These eyes would behave like any other case of strabismus, with

motor success being more likely. We do not know whether it has clinical significance, but for

practical purposes the surgical success should be quoted as 71% instead of 74%, excluding

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these patients.

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Follow-up of 2 months is too little for judging motor outcomes; the standard deviation

is very large, and the median value would be a better indicator of success. From the table it

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appears that most of the patients with surgical success had 2 months’ follow-up only, which

is too less. No sensory fusion also influences the long-term motor outcomes.

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The results of the study appear promising. Despite the difficulty in tissue
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maneuverability, the data reveals that ocular alignment in these can be restored successfully
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without compromising the integrity of the buckle and disposing the patient to reoperation of

the retina.
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Savleen Kaur, MS

Mohit Dogra, MS
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Jaspreet Sukhija, MS
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Mangat R. Dogra, MD
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Advanced Eye Centre, Postgraduate Institute of Medical Education and Research,

Chandigarh, India

References

1. Osigian CJ, Rothfield L, Rabina G, et al. Strabismus surgery outcomes without

removal of scleral buckle in patients with previous retinal detachment repair. Epub
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ahead of print, July 5, 2018. J AAPOS.

2. Kim A, Nejad M, Pineles S, Chang M, Velez F. A modified technique for strabismus

surgery in the presence of a scleral buckle. J AAPOS. 2016;20:376-8.

3. Ganekal S, Nagarajappa A. Strabismus following scleral buckling surgery. Strabismus

2016;24:16-20.

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4. Kasbekar SA, Wong V, Young J, Stappler T, Durnian JM. Strabismus following

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retinal detachment repair: a comparison between scleral buckling and vitrectomy

procedures. Eye (Lond) 2011;25:1202-6

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