Towards Standardized Primary Strabismus Surgery: A Systematic Approach for a Surgical Plan
Mari M. Gutter, MSc; Marijke R.C. Luijten, MA; Jan-Roelof Polling
HU-University of Applied Sciences
Introduction: Planning for strabismus surgery is a complex process and involves various variables. According to Dutch law, orthoptists in the Netherlands advise the surgeon about the plan for strabismus surgery. The purpose of this study was to investigate whether a newly developed mind map ‘Primary Strabismus Surgery’ (MM-PSS) could standardize the plan for surgery.
Methods: Four fictitious cases on paper of primary strabismus surgery were created consisting of a decompensated microtropia, intermittent exotropia, non-specific esotropia and a case with high risk of post-operative diplopia. Twenty-four final year orthoptists-in-training from HU-University of Applied Sciences were asked to formulate a surgical plan in these four cases. After receiving the MM-PSS these same students were assigned to create again a surgical plan in four comparable fictitious cases.
Results: In case microtropia, non-specific esotropia and adult with high risk of post-operative diplopia there was a significant increase in consistency in choice of the target angle (resp. p=0.022, p=0.039, p<.001) as well as performing additional diagnostics for surgery in case intermittent exotropia (p=0.012). No significant improvement was shown in the investigation for post-operative diplopia (p=0.459).
Discussion: Evidence based guidelines summarized in a new developed MM-PSS provided to orthoptists-in-training reduced the variety in plans for strabismus surgery. Higher level of evidence especially in setting terms for surgery is required to update the MM-PSS and improve the choice of surgery.
Conclusion: The MM-PPS is an effective tool for orthoptists-in-training and residents in approaching the plan for primary strabismus surgery.