Is Muscle Shortening Surgery for Strabismus a Long-Term Solution?

Is using muscle recession for strabismus a more long-lasting solution?

My situation is quite special...
I have had amblyopia since childhood (starting at age 4 due to an eye injury).
Currently, my left eye has myopia and astigmatism of about 300-400 degrees, while my right eye has normal vision with no myopia.
My left eye also has a strabismus of approximately 18 degrees (which is considered significant).
Due to the difficulty of patching therapy when I was young, I gradually developed strabismus that persisted into adulthood.
At around 21 years old, I underwent my first strabismus surgery.
I didn't ask the doctor in detail about the method used; I only knew that less than a month after the surgery, my strabismus returned, essentially making the surgery ineffective (I only felt normal for a few days right after the operation).
I don't know why this happened; the doctor only told me it was "under-corrected." Personally, I suspect it might be due to the "knot" loosening or not being tied properly.
In any case, I don't want to pursue this matter further.

Now, I am considering a second strabismus surgery, but when I asked some doctors, they said that due to my long-standing amblyopia and poor fusion ability, along with the significant disparity between my two eyes, even if I undergo surgery again, the outcome may not be ideal.
The shadow of my previous surgical failure has made me hesitant, as I am very afraid of experiencing another setback.

Given my situation, would a second surgery still be ineffective? If the "muscle recession" technique is used, would it provide a more lasting result? (I prefer not to use tying methods to avoid loosening.) Thank you, doctor.

xin qing ju sang de ren, 20~29 year old female. Ask Date: 2017/10/15

Dr. Cai Wenyuan reply Ophthalmology

Hello, I apologize, but your question may be better discussed with the surgeon.
Wishing you safety and health.
Sincerely, Dr.
Tsai Wen-Yuan, Director of the Ophthalmology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2017/10/15

More Info

Muscle shortening surgery for strabismus, often referred to as muscle resection or muscle shortening, can be a viable option for correcting misalignment of the eyes. However, whether it serves as a long-term solution depends on various factors, including the underlying cause of the strabismus, the specific surgical technique employed, and the individual’s unique anatomical and physiological characteristics.

In your case, having a history of amblyopia (lazy eye) and significant refractive errors in one eye complicates the situation. Amblyopia can lead to a reduced ability of the brain to process visual information from the affected eye, which may affect the overall success of any surgical intervention. The fact that you experienced a recurrence of strabismus shortly after your first surgery suggests that the initial correction may not have adequately addressed the underlying muscle imbalance or that other factors, such as the strength of the eye muscles or the neural control of eye movements, were not optimal.

When considering a second surgery, it is crucial to have a thorough preoperative evaluation. This evaluation should include a comprehensive assessment of your eye alignment, muscle function, and any potential neurological factors that may contribute to your strabismus. The choice of surgical technique is also vital. Muscle shortening (resection) can provide a more permanent solution compared to other methods, such as muscle recession, which involves repositioning the muscle rather than shortening it. However, the success of muscle shortening surgery is not guaranteed, especially in cases with significant amblyopia or poor binocular function.

It’s also important to note that surgical outcomes can vary widely among individuals. Factors such as age, the degree of strabismus, and the presence of other ocular conditions can influence the effectiveness of the surgery. In some cases, additional treatments, such as vision therapy or corrective lenses, may be recommended in conjunction with surgery to enhance the overall outcome.

In your situation, it would be beneficial to consult with a strabismus specialist who has experience with complex cases, particularly those involving amblyopia and previous surgical failures. They can provide a tailored approach based on your specific needs and may suggest alternative strategies, such as a combination of surgical and non-surgical interventions, to improve your eye alignment and visual function.

In summary, while muscle shortening surgery can be a long-term solution for strabismus, its success is contingent upon a variety of factors, including the individual’s unique circumstances and the surgical approach taken. A thorough evaluation by a qualified specialist is essential to determine the best course of action for your specific case.

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