Subspecialists differ on treating intraoperative strabismus surgery complication

J Pediatr Ophthalmol Strabismus. 2011;48(4):232-237.

Pediatric ophthalmologists and vitreoretinal surgeons preferred significantly different approaches to initial management of scleral perforation during strabismus surgery, a study found.

"Perforation can predispose to several risks, which include retinal hemorrhage, retinal detachment and endophthalmitis," the authors said. "However, the incidence of these complications after perforation is low, and therefore treatment remains controversial."

An anonymous online survey was presented to 665 pediatric ophthalmologists and 494 vitreoretinal surgeons. A total of 169 ophthalmologists responded: 133 pediatric ophthalmologists (20%) and 36 vitreoretinal surgeons (7.3%).

Study results showed that 35% of pediatric ophthalmologists and 8% of vitreoretinal surgeons cited observation as the preferred method of initial treatment; the difference was statistically significant (P = .001).

"Unlike the eyes of an adult, the vitreous is formed in the eyes of a child and can potentially provide additional protection from retinal detachment," the authors said. "Although many pediatric ophthalmologists perform strabismus surgery on adults and children, pediatric ophthalmologists may perceive a measure of safety provided by the formed vitreous in children."

According to the data, 13% of pediatric ophthalmologists and 22% of vitreoretinal surgeons stated a preference for laser treatment. In addition, 88% of pediatric ophthalmologists and 57% of vitreoretinal surgeons advocated the use of antibiotics during initial treatment. The difference was statistically significant (P < .001).

Pediatric ophthalmologists did not perceive method of treatment affecting outcome, while vitreoretinal surgeons viewed laser photocoagulation as yielding the best outcome (P = .03), the authors said.