Adaptive response plays role in strabismus surgery outcomes

NASHVILLE, Tenn. — The adaptive response to surgery has a positive influence on strabismus correction outcomes, softening perhaps the rigor of the dose-response relationship, Steven M. Archer, MD, suggested in his delivery of the Costenbader Lecture at the American Association for Pediatric Ophthalmology and Strabismus annual meeting.

“Strabismus surgery is as successful as it is because patients often have an adaptive response to the surgery that favors them being straight,” Archer said.

Steven M. Archer

In a retrospective review of strabismus surgery studies, Archer looked at outcomes influenced by preoperative deviation and by surgical amount. While both factors independently and together influence surgical response, Archer’s review found that about 15% of surgical response could not be accounted for with either factor and that preoperative deviation was more predictive than amount of surgery.

“Basically in every case where multivariate analysis was done or I could go back and calculate it, the preoperative deviation is a better predictor of surgical response than the amount of surgery,” Archer said.

Archer further noted average amounts of surgery done for various deviations and noted average amounts of response. Most patients’ responses were close to average, but for those who were not average, the patients with less than the average amount of surgery had more than the average amount of response and those with more than the average amount of surgery had less than the average response.

“Basically, these patients, at least within a certain range, are adjusting their response to achieve a straight result,” he said.

Effects of strabismus surgery are both mechanical and biological, Archer said, with the complex biological component being under study.

The lecture was supported by the Children’s Eye Foundation, which announced at the meeting the initiation of the Pediatric Ophthalmology and Strabismus Hall of Fame. – by Patricia Nale, ELS

Reference:

Archer SM. Costenbader Lecture: Why strabismus surgery works: The legend of the dose-response curve. Presented at: American Association for Pediatric Ophthalmology and Strabismus annual meeting; April 2-6, 2017; Nashville, Tenn.

Disclosure: Archer reports no relevant financial disclosures.