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Jampolsky Lecture

Reoperation Strategies

Burton J. Kushner, MD

Purpose: To outline a systematic approach to strabismus reoperations.

Target Audience: Pediatric ophthalmologists and strabismologists

Current Practice: Many strabismologists have a formulaic approach to strabismus reoperations, e.g. treat it as a fresh case, advance previously recessed muscles to the original insertion, etc.

Best Practice: Effective strategies for strabismus reoperations are not formulaic and should be tailored to the specific history and findings of the patient. The first, and most important decision, is whether to operate on previously operated muscles or fresh muscles. This should be influenced, in part, by whether one is treating an overcorrection or undercorrection. Limitations of rotations and incomitance patterns should be addressed. Many important decisions should be made intraoperatively based on where muscles are found, their integrity (slipped in the capsule, stretched scar, etc.), repeated intraoperative forced ductions, and spring back balance testing.

Expected Outcomes: Orthophoria! (AKA improved results with reoperation strabismus cases.

Format: This presentation will be a narrative of pearls gained from the speaker’s 40+ years in practice.

Summary: A proper plan for a strabismus reoperation takes into account a number of preoperative factors, and the surgeon should be prepared to modify the plan based on intraoperative findings.

References

  1. Cooper EL. The surgical management of secondary exotropia. Trans Am Acad Ophthalmol Otolaryngol 1961;65:595-608.
  2. Kushner B. Reoperations. Strabismus: Practical pearls you won’t find in textbooks. New York: Springer; 2017:305-10.
  3. Jampolsky A. Spring-back balance test in strabismus. Transactions of the New Orleans Academy of Opththalmology. St Louis: Mosby; 1978:104-11.
  4. Guyton DL. Exaggerated traction test for the oblique muscles. Ophthalmology 1981;88:1035-40.
  5. Jampolsky A. Strategies in strabismus surgery. Pediatric Ophthalmology and Strabismus Transactions of the New Orleans Academy of Ophthalmology. New York: Raven Press;
  6. Parks MM. Slipped, disinserted or severed, and lost muscles. In: Rosenbaum A, Santiago AP, eds. Clinical Strabismus Management. philadelphia: W. B. Saunders; 1999:529-38.
  7. Kushner B. Complications of eye muscle surgery. Strabismus: Practical pearls you wont find in textbooks. New York: Springer; 2017:193-207.
  8. Ludwig IH. Scar remodeling after strabismus surgery. Trans Am Ophthalmol Soc 1999;97:583-651.

Schedule

9:35–9:40 AM
Introduction of the Jampolsky Lecturer – Thomas D. France, MD

9:40–10:05 AM
Jampolsky Lecture – Burton J. Kushner, MD

10:05–10:08 AM
Presentation Ceremony – John A. Brabyn, PhD

March 19 @ 09:35

09:35

– 10:10

(35′)

International Ballroom Center

Burton J. Kushner, MD

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