Ophthalmology Outcomes
Adult Strabismus
The Adult Strabismus Service at Mass Eye and Ear provides comprehensive diagnoses and treatments for adults with strabismus. Treatment can include prism therapy, Botox® injections, or strabismus surgery. The service is one of the few in the country that performs strabismus surgery specifically in adults and is distinct from the Mass Eye and Ear Pediatric Ophthalmology and Strabismus Service, which is affiliated with Boston Children’s Hospital.
Learn more about strabismus care at Mass Eye and EarPreoperative Symptoms in Adult Strabismus Surgery Patients
During the 2023 calendar year, the Adult Strabismus Service performed strabismus surgery on 199 patients. The majority of patients (91.5% or 182/199 patients) had diplopia pre-operatively. Diplopia was also a common pre-operative symptom in prior calendar years, as shown above.
Underlying Etiologies Associated with Adult Strabismus Surgery
Of the 199 strabismus surgery cases performed in calendar year 2023, the most common etiology was idiopathic or congenital strabismus (46.2% or 92 patients). Thyroid eye disease was the second most common cause (13.6% or 27 patients). Other etiologies included traumatic and post-surgical strabismus (13.1% or 26 patients), sagging eye syndrome (11.1% or 22 patients), sensory exotropia (5.5% or 11 patients), fourth nerve palsy (2.5% or 5 patients), sixth nerve palsy (2.0% or 4 patients), skew deviation (1.5% or 3 patients) and post-radiation (1.0% or 2 patients). The remaining etiologies (3.5% or 7 patients) were third nerve palsy, stroke, Duane syndrome, Brown syndrome, autosomal recessive cerebellar ataxia type 1 (ARCA1), spinocerebellar ataxia type 6 (SCA6) and ocular myasthenia gravis.
Success Rates for Adult Strabismus Surgery at Six Months Follow-up
In calendar year 2023, 182 of 199 patients (91.5%) had diplopia prior to their surgeries. Of these 182 patients, 135 had between one- and six-month follow-up data available, and therefore, were included in the above analysis.
Postoperatively, overall success in 2023 was 85.2% which includes patients without diplopia in primary position or with a deviation of less than six prism diopters after a single surgery that did not require prism glasses at their six-month follow-up appointment [95 of 135 patients (70.4%)] plus patients who had diplopia after surgery but were without diplopia in primary position with prism glasses [20 of 135 patients (14.8%)].
Two of 135 patients (1.5%) required a second surgery that was performed within six months.
The remaining 18 of 135 patients (13.3%) had persistent diplopia at their follow-up appointment closest to six months.
Of the 199 patients that had strabismus surgery, 185 patients (93.0%) had the adjustable suture technique, and fourteen patients (7.0%) had a non-adjustable procedure.
Of the 185 patients who underwent an adjustable procedure, 44 patients (23.8%) needed an adjustment in the immediate post-operative period, two to three hours following surgery.
There were zero cases that were complicated by scleral perforation and zero cases developed an infection within 30 days of surgery. These results are the same as in calendar years 2012 to 2022.
