Strabismus surgery outcomes in eyes with glaucoma drainage devices

Abstract

Purpose: To report strabismus surgery outcomes in eyes with prior implantation of glaucoma drainage devices (GDD).

Methods: The medical records of patients who underwent strabismus surgery for ocular misalignment that developed after implantation of a GDD over a 13-year period at a single institution were examined retrospectively. Patient characteristics, deviation types, preoperative measurements, surgical procedures, and postoperative measurements were analyzed.

Results: Of the 16 patients included, 14 had exotropia (34^Δ ± 16^Δ) and 11 had vertical deviations (15^Δ ± 7^Δ), of which 9 had concurrent exotropia and vertical deviations. Preoperatively, 9 patients had diplopia. The surgical approach was tailored to address the deviation most noticeable to the patient-horizontal, vertical, or both if the vertical component could be addressed by horizontal muscle supra- or infraplacement. Three patients underwent simultaneous horizontal and vertical surgery. All patients underwent strabismus surgery on an eye with a GDD. Surgical motor success (defined as horizontal deviation ≤10^Δ, vertical ≤4^Δ) was achieved in 42% of horizontal and 57% of vertical deviations. Postoperatively 74% of deviations decreased by ≥50% in magnitude. Diplopia resolved in 50% of patients who presented with preoperative diplopia. One patient had intraoperative bleb perforation, but none had postoperative hypotony at any follow-up visit. Only 2 required a second strabismus surgery.

Conclusions: Strabismus surgery with preservation of the filtering bleb following implantation of a glaucoma drainage device is a low risk procedure that can improve ocular alignment and related symptoms, despite a low motor success rate by standard criteria.