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Drift of ocular alignment following strabismus surgery. Part 1: using fixed scleral sutures
  1. P Pukrushpan1,2,
  2. S J Isenberg2
  1. 1
    King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
  2. 2
    Jules Stein Eye Institute, 100 Stein Plaza, UCLA David Geffen School of Medicine, Los Angeles, California, USA
  1. Dr S J Isenberg, Jules Stein Eye Institute, 100 Stein Plaza, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA; isenberg{at}


Aims: To evaluate the postoperative alignment drift following traditional strabismus surgery utilizing direct attachment of muscle to sclera.

Methods: The ocular alignment drift (change from the first postoperative week) of 106 patients who underwent scleral fixation strabismus surgery at age 0.5 to 35 years with 5 years’ maximal follow-up was analysed.

Results: There was a mean undercorrection drift of 4.6 (SD 8.9) prism dioptres (PD) at distance fixation (p = 0.025) and 3.4 (7.6) PD at near (p = 0.053) for all subjects, and 11.3 (8.6) PD distance (p = 0.008) and 10.6 (6.0) PD near (p = 0.016) for exotropic patients. Recession surgery produced an undercorrection drift of 5.3 (8.8) PD (p = 0.021) at distance fixation. Esotropic patients and those undergoing unilateral recession/resection surgery had no significant drift. Patients overcorrected at the 1-week postoperative visit later developed an undercorrection drift at distance (10.3 (7.9) PD, p = 0.002) and near fixation (5.5 (9.2) PD at 36 months, p = 0.041), while undercorrected patients showed no significant drift and largely stayed undercorrected.

Conclusion: Fixed scleral-suture strabismus surgery generally produces a postoperative undercorrection drift, especially following recession surgery, exotropia or overcorrection at the first postoperative week.

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  • See Editorial, p 419

  • Competing interests: None.

  • Ethics approval: Ethics approval was provided by the Institution Review Board of the Office for Protection of Research Subjects of UCLA.

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