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Round table: Panelists trend toward minimal steroid use after strabismus surgery
In this fourth excerpt from a round table conducted at the 2011 AAPOS meeting, members of the OSN Pediatrics/Strabismus Section address postop regimens for strabismus surgery.
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 Robert S. Gold |
 Erin D. Stahl |
Robert S. Gold, MD: Let’s talk about what each of you do postoperatively for your strabismus patients. Do you put them on medication, and what kind of follow-up appointments do you set up?
Erin D. Stahl, MD: Preoperatively I use Betadine (povidone iodine, Purdue Pharma) and then one drop postoperatively followed by Maxitrol ointment (neomycin, polymyxin B sulfates, dexamethasone ophthalmic suspension, Alcon) in the operating room. No drops go home with the patient. I see them 4 days afterward and 4 to 6 weeks after that.
Roberto Warman, MD: I use TobraDex ointment (tobramycin dexamethasone, Alcon). I tell the parents to try to put it in for 3 nights in a row, but I honestly do not care too much if it goes in or not. It is not a big deal. Then, I do offer all my patients the option of coming in the next day, but that is more of a social visit. Because many patients are from far away, I actually sometimes do not see them for several weeks after, but in theory, I see them a week later, mostly so the resident continues follow-up of them and can learn from them.
 Roberto Warman |
 Anthony P. Johnson |
Anthony P. Johnson, MD: I use a nonsteroidal drop afterward three times a day for about 5 days — no antibiotic or steroid — and I see them back in about 2 weeks and then a 6-week follow-up visit for sort of a final result.
Scott E. Olitsky, MD: I use preoperative and postoperative Betadine and one dose of Maxitrol. I have not really seen too many problems with the neomycin, either because there is steroid in it or perhaps because I give just one dose, but it does not go home with patients. I typically see patients 3 to 4 days afterward and then in about 6 to 8 weeks. If I have patients coming from a long distance, I have the family call me 3 or 4 days later just to make sure the child is doing OK.
Kenneth P. Cheng, MD: I kind of like the idea of the postoperative Betadine drop. It is probably a reasonable idea, but it is something I have not done. Patients get Betadine before surgery. In somebody who has not had any strabismus surgery before, I do not use any drops at all. I am not so sure they really do anything.
 Scott E. Olitsky |
 Kenneth P. Cheng |
We are an unusual mix here, because I do think that most people use antibiotic steroid combination drops for a little while after surgery. I am kind of pleased to hear that I am not alone, because I was feeling like I was alone in my community.
For patients who are re-operations, I put them on TobraDex for 1 week. In terms of postoperative follow-up, I see patients between 1 and 3 weeks later. I tell the family that the redness of the eye, tearing and mucous should stay the same or get better. It should not get worse. I ask them to call me if there is any increase in redness or if there are any problems of drainage or discharge.
Dr. Gold: I use Betadine preoperatively in the procedure. I irrigate Betadine in the eye. I do put patients on an antibiotic steroid, usually TobraDex. It is a small bottle. I tell them to use it two or three times a day until it runs out, which is only about 3 or 4 days. Then I see them back anywhere from 3 to 10 days after the surgery for the first time and then about 6 weeks after.
- Kenneth P. Cheng, MD, can be reached at 1000 Stonewood Drive, Suite 310, Wexford, PA 15090; 724-934-3333; email: kpc123@verizon.net.
- Robert S. Gold, MD, can be reached at 790 Concourse Parkway South, Suite 200, Maitland, FL 32751; 407-767-6411; fax: 407- 767-8160; email: rsgeye@aol.com.
- Anthony P. Johnson, MD, can be reached at Jervey Eye Group, 601 Halton Road, Greenville, SC 29607; 864-458-7956; fax: 864-458-8390; email: apj@jervey.com.
- Scott E. Olitsky, MD, can be reached at Children’s Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, MO 64108; 816-234-3000; fax; 816-346-1375; email: seolitsky@cmh.edu.
- Erin D. Stahl, MD, can be reached at Children’s Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108; email: edstahl@cmh.edu.
- Roberto Warman, MD, can be reached at Miami Children’s Hospital, 3200 SW 60th Court, Suite 103, Miami, FL 33155-4072; 305-662-8390; fax: 305-661-7862; email: rwarman@eyes4kids.com.
- Disclosures: Drs. Cheng, Gold, Johnson, Olitsky, Stahl and Warman have no relevant financial disclosures.