Surgery to correct strabismus caused a sharp decline in vision. Recovery after strabismus surgery

10.03.2020 -

The ultimate goal of strabismus surgery is to restore symmetrical (or as close to symmetrical) eye position as possible. Such operations, depending on the situation, can be performed both in adults and in children.

Types of surgeries to correct strabismus

In general, there are two types of operations for strabismus. The first type of operations is aimed at relaxing excessively tense oculomotor muscle. An example of such operations is recession (crossing a muscle at its insertion and moving it in such a way as to weaken its action), partial myotomy (partial excision of part of the muscle fibers), muscle plastic (for the purpose of lengthening). The second type of surgery is aimed at strengthening the action of the weakened extraocular muscle. An example of operations of the second type is resection (excision of a section of weakened muscle near the attachment site with subsequent fixation of the shortened muscle), tenorrhaphy (shortening of the muscle by forming a fold in the muscle tendon area), anteposition (moving the site of muscle fixation in order to enhance its action).

Often, a combination of the above types is used during surgery to correct strabismus. surgical intervention(recession + resection). If after execution surgical intervention there is residual strabismus that is not leveled by self-correction; it may be necessary reoperation, which is usually performed after 6 – 8 months.

To achieve maximum effectiveness when performing surgery to correct strabismus, you must adhere to several basic principles.

1. Unnecessarily forcing the process surgical correction strabismus often leads to unsatisfactory results. Therefore, all manipulations should be carried out in doses (if necessary, in several stages).

2. If it is necessary to weaken or strengthen individual muscles, dosed surgical intervention should be distributed evenly.

3. When performing surgery on a specific muscle, it is necessary to maintain its connection with the eyeball.

High-tech strabismus surgery:

Children's specialists eye clinics modern high-tech radio wave surgery with the principles of mathematical modeling has been developed.

Advantages of high-tech eye surgery:

The operations are low-traumatic; thanks to the use of radio waves, the structures of the eye are preserved.
After the operations there is no terrible swelling, the patient is discharged from the hospital the next day.
Operations are precise.
Thanks to the principles of mathematical calculation, we can ensure the highest accuracy and show the guaranteed result of the operation even before it is carried out.
The rehabilitation period is reduced by 5-6 times.

Result of the operation: highly effective strabismus surgery technologies make it possible to ensure a symmetrical gaze position in various types of strabismus, including those with small and unstable angles, and to restore the mobility of the eyeball in paralytic strabismus in 98% of cases. This unique way effectively help the patient.

Results of surgery for strabismus

Surgery strabismus allows you to correct a cosmetic defect, which is a strong traumatic factor for patients of any age. However, to restore visual functions(those. binocular vision) after surgery, a comprehensive approach is required, which includes pleoptic therapy (it is aimed at treating amblyopia accompanying strabismus) and orthoptodiploptic therapy (restoration of depth vision and binocular functions).

A one-stage operation to correct strabismus in adults can be performed on an outpatient basis; when treating children, hospitalization is necessary in most cases. The approximate recovery time after surgery is 1 week, but to recreate full binocular vision, i.e. The ability to see a three-dimensional image with both eyes at the same time is not enough. During the time that a person had strabismus, the brain, figuratively speaking, “forgot how” to combine images from both eyes into a single image, and it will take quite a long time and significant effort to “teach” the brain this again.

It should be mentioned that, like any operation, surgical correction strabismus may be accompanied by the development of certain complications. One of the most common complications of strabismus surgery is excessive correction (so-called hypercorrection), caused by errors in calculations. Overcorrection may occur immediately after surgery, or may develop after some time. For example, if the operation was performed in childhood, then in adolescence As the eye grows, the child may develop squint again. This complication is not irreparable and can be easily corrected with surgery.

This surgical intervention is performed in most ophthalmological centers in Moscow and Russia (both commercial and public). When choosing a clinic for an operation to correct strabismus, it is important to study the clinic’s capabilities, living conditions, whether the clinic is equipped with modern equipment and other important points. It is equally important to choose the right doctor to perform the operation. After all, the prognosis of treatment will fully depend on his professionalism.

If you or your relatives have already undergone surgery to correct strabismus, we will be grateful if you leave feedback about the intervention and the clinic where the procedure was performed, as well as the results obtained

The goal of surgery on the extraocular muscles for strabismus is to achieve correct eye position and, if possible, restore binocular vision. However, the first step in the treatment of childhood strabismus is the correction of any significant refractive errors and/or amblyopia. Once the maximum possible visual function has been achieved in both eyes, any residual deviation must be corrected surgically.

surgeries that weaken muscle action

This is the weakening of a muscle by moving its insertion posteriorly towards the origin of the muscle. Recession can be performed on any muscle except the superior oblique.

a) exposure of the muscle belly is achieved through an inferotemporal arcuate incision;

b) one or two absorbable sutures are placed on the muscle near its insertion;

Rear fixation seams

The principle of this intervention (Faden operation) is to reduce the strength of the muscles in the direction of their action without changing the place of attachment. The Faden procedure can be used to treat VDD and also to weaken the horizontal rectus muscles. When correcting VDD, recession of the superior rectus muscle is usually performed first. The belly of the muscle is then sutured to the sclera with a non-absorbable suture at a distance of 12 mm posterior to its insertion.

a) after exposure of the muscle, two absorbable sutures are passed through the muscle at marked points posterior to its insertion;

b) part of the muscle anterior to the sutures is excised, and the stump is sutured to the original site of attachment

3. Education muscle or tendon folds are usually used to enhance the action of the superior oblique muscle in congenital fourth cranial nerve palsy.

2. Moving(suturing the muscle closer to the limbus) may provide enhanced action after previous rectus recession.

a) recession of the internal rectus muscle;

b) the lateral halves of the superior and inferior rectus muscles are cut off and sutured to the superior and inferior edges of the paretic lateral rectus muscles

2. Operation Jensen improves abduction, and is combined with recession or injection of CI toxin. bolulinum into the external rectus muscle.

Superior oblique paralysis

1. Congenital hypertropia with a large angle in the primary position. In this case, a fold of the superior oblique muscle is performed.

2. Acquired

A) small hypertropia is corrected by ipsilateral weakening of the inferior oblique muscle;

b) acquired Medium- and large-angle hypertropias are treated with ipsilateral inferior oblique weakening combined with ipsilateral superior rectus weakening and/or contralateral superior rectus weakening. It must be taken into account that weakening of the inferior oblique and superior rectus muscles of the same eye can lead to hyperelevation;

2. The two ends of the thread are passed close to each other together through the stump at the site of attachment.

3. The second suture is tied and pulled tightly around the muscle suture in front to secure it from the stump.

5. The conjunctiva remains open.

3. If greater recession is required, the knot is pulled anteriorly along the muscle suture, providing additional relaxation of the recessioned muscle, and pushed posteriorly.

4. If less recession is required, the muscle suture is pulled anteriorly and the knot is pulled in the direction opposite to the muscle stump.

5. The conjunctiva is sutured.

A similar technique is used for resection of the rectus muscle.

Chemodenervation with botulinum toxin for strabismus

Main indications for chemodenervation:

To determine the function of the external rectus muscle in CN VI palsy, in which contracture of the internal rectus muscle interferes with abduction. A small dose of CI toxin. bolulinum is injected into the belly of the antagonist in the hyperfunction (internal rectus muscle) under electromyographic control. Temporary paralysis of the muscle causes it to relax, and the action of the horizontal muscles of the eye is balanced, allowing the function of the external rectus muscle to be assessed.

To determine the risk of postoperative diplopia and assess the potential of BZ. For example, an adult patient with left divergent strabismus and high visual acuity in both eyes receives an injection of CI toxin. bolulinum into the external rectus muscle of the left eye will result in either eye alignment or convergence.

However, placing a corrective prism in front of the deviated eye is often a simpler and more accurate method of assessing the risk of postoperative diplopia. If one of the methods indicates the possibility of diplopia, the patient can be informed about this. However, such a dilopia. usually disappears spontaneously.

Eye surgery to correct strabismus

Often, strabismus surgery does not immediately return normal vision. Many will agree that it is a pity to look at a young, pretty girl or child looking askance. Without this cosmetic defect everything would be fine. In addition, ophthalmologists recommend that before going under the knife, try conservative methods treatment of strabismus.

What is strabismus, or strabismus?

Strabismus is a pathology in which one, both, or alternately the right and left eyes deviate from the normal position when looking straight. When a person looks at an object, the information received by each eye is slightly different, but the visual analyzer in the cortical part of the brain brings everything together. With strabismus, the pictures are very different, so the brain ignores the frame from the squinting eye. The long-term existence of strabismus leads to amblyopia - a reversible functional decrease in vision, when one eye is practically (or completely) not involved in the visual process.

Strabismus can be congenital or acquired. Newborns often have a floating or sideways gaze, especially after a difficult birth. Treatment by a neurologist can remove or alleviate the manifestations of birth trauma. Another cause may be a developmental abnormality or improper attachment of the extraocular muscles (see Fig. 1).

Acquired strabismus occurs as a result of:

infectious disease: influenza, measles, scarlet fever, diphtheria, etc.;
somatic diseases;
injuries;
a sharp drop in vision in one eye;
myopia, farsightedness, high and moderate astigmatism;
stress or severe fear;
paresis or paralysis;
diseases of the central nervous system.

How can you get rid of strabismus?

Strabismus corrects:

wearing special glasses;
a series of eye exercises;
wearing a blindfold covering one eye;
surgery to correct strabismus.

Variable strabismus, when sometimes the right or left eye squints, is tried to be corrected by wearing a bandage. Long-term use of specially designed glasses often helps. Exercises to strengthen the ability to focus are recommended for almost all patients with strabismus. If all of the above methods do not correct vision, surgery is performed to correct strabismus. This type Surgery is performed both in infancy and in adulthood.

Types of surgeries to correct strabismus

Occurs in children and adults the following types strabismus:

horizontal - converging and diverging relative to the bridge of the nose;
vertical;
combination of two types.

Doctors encounter convergent strabismus more often than divergent strabismus. Along with converging strabismus, the patient may have farsightedness. U myopic people divergent strabismus is usually observed.

During the operation the following can be performed:

amplification type surgery;
debilitating surgery.

During weakening surgery eye muscles transplanted a little further from the cornea, which deviates the eyeball in the opposite direction.

During augmentation surgery, a small piece of the eye muscle is removed, causing it to shorten. This muscle is then sutured to the same place. Surgery to correct strabismus involves shortening and weakening the target muscles, which restores balance to the eyeball. The operation is performed on one or both eyes. The microsurgeon determines the type of surgical intervention when the patient is in a completely relaxed state on the operating table.

In some clinics the operation is performed under local anesthesia only for adults. and in others, all patients are given general anesthesia. Depending on age, health status and other factors, mask (laryngeal), endotracheal anesthesia using muscle relaxants, or an alternative type of anesthesia is performed.

It is important that during surgery the eyeball is motionless and there is no tone in the muscles, because the surgeon conducts a special test: he evaluates the degree of restriction of eye movements by moving it in different directions.

After surgery, an adult can go home on the same day. The child needs preliminary hospitalization. Most often, mothers are in the hospital with their children; discharge occurs the next day after the operation. Recovery period takes about 14 days. After discharge, the patient extends sick leave or a certificate from your clinic.

It should be noted that in 10-15% of cases, strabismus is not completely eliminated and repeated surgery may be necessary. Surgery using adjustable sutures helps reduce the failure rate. After the patient wakes up, the doctor checks the condition of the eyes after some time under local anesthesia. If there are deviations, he slightly tightens the suture knots and only then finally secures them. All types of operations are performed with completely absorbable suture material.

Adults who have lived for a significant period of time with strabismus sometimes experience double vision after surgery because the brain is unaccustomed to perceiving a binocular image. If before the operation the doctor has determined that there is a high probability of developing double vision, the correction of strabismus is done in two stages so that the brain can gradually adapt.

Carrying out the operation

A few days before surgery, you need to take blood tests, do an ECG and undergo a consultation with some specialists. You should not eat 8 hours before surgery. If it is scheduled for the morning, you can have dinner, and if it is in the afternoon, then a light breakfast is allowed. The child and mother are admitted to the hospital a couple of days before the operation. The procedure is performed under general anesthesia. The operation itself lasts 30-40 minutes, then the patient is taken out of anesthesia and transferred to the ward. All this time, a bandage is placed on the eye. After the operated patient has completely recovered from anesthesia, he is examined by a surgeon in the afternoon. He opens the bandage, checks the eye, puts some drops in special drops and closes it again. After this, adults are sent home with detailed recommendations: what medications to take, what to put in their eyes, and when to come for a second examination. The eye patch is left on until the morning next day. After a week, you need to come for an examination, where the doctor will assess the healing speed and condition of the eye. The final assessment of eye position is carried out after 2-3 months.

For several weeks after surgery, use special anti-inflammatory drops and (if necessary) antihistamines. The eye will be red and swollen. Sometimes the next morning the eye will stick together due to accumulated pus. No need to be scared: it is washed with warm boiled water or sterile saline solution. For a couple of days the eyes will be very watery and sore, and it will also seem as if there are specks in the eye. The sutures dissolve on their own after 6 weeks.

For a month after surgery, you need to carefully protect your eye. You cannot swim, stay in dusty areas or play sports. Children at school are exempted from physical education for six months.

A month after the operation you need to undergo a course of treatment. To regain the binocular ability to see and recognize the correct picture, you need to undergo a special hardware treatment V medical center. Some clinics have the Amblicor complex, developed by specialists from the Brain Institute. Treatment using this device is a computer video training. It helps overcome the skill of suppressing vision in one eye. While watching a cartoon or movie, an EEG of the visual cortex of the brain and readings about eye function are continuously taken from the patient. If a person sees with both eyes, the film continues, and if only with one, it pauses. Thus, the brain is trained to perceive the image from both eyes.

Strabismus in children

Detected strabismus in children under one year of age will not heal on its own, the child will not outgrow it, and the pathology will not disappear anywhere. If the disease is present and the symptoms can be identified, treatment cannot be delayed. Otherwise an unused squinting eye loses the ability to see and develops farsightedness or amblyopia– lazy eye syndrome.

When the visual apparatus works in a coordinated manner, the muscles of both eyes work together and focus the gaze on one point in space. In the case of strabismus, the work of the eye muscles is uncoordinated and joint movement of the eyes becomes impossible.

Each eye is directed in its own direction (convergent or divergent strabismus), as a result of which the brain is not able to determine the amount of incoming information and combine two images into one.

Causes

Convergent strabismus in a child can be caused by the following reasons:

congenital (non-permanent) strabismus - may be present from birth or occur in the first months of life. The reasons lie in intrauterine processes; infectious diseases mother or the consequences of microscopic hemorrhage;
impaired visual acuity (ametropia), causes: farsightedness, myopia, astigmatism;
consequence of disturbances in the functioning of the child’s central nervous system, causes – children’s cerebral paralysis, hydrocephalus;
acquired (amblyopia) – past illnesses: diphtheria. measles, flu, rubella;
consequences of fright or severe stress;
injuries, fractures, bruises.

Strabismus, depending on the timing of appearance, causes of occurrence, complexity and degree of manifestation, can be: non-permanent, descending, hidden, friendly, imaginary.

Sometimes parents are terribly frightened by diagnoses of amblyopia. descending or imaginary strabismus in children under one year of age, although such phenomena are temporary and are caused by the immaturity of the visual apparatus, conductive channels and nerve endings.

Symptoms

Convergent strabismus in children of any age is determined by the following signs:

the child is unable to direct both eyes simultaneously to one arbitrarily chosen point (convergent, divergent or alternating strabismus);
non-friendly eye movement;
one eye visibly squints or closes in bright light (amblyopia);
the child has an involuntary desire to tilt his head at a certain angle in order to look at an object (hidden strabismus);
impaired perception of spatial depth (the child may fall or bump into objects).

In children preschool age and older people may attend Complaints of blurred vision, eye strain, increased photophobia, or objects appearing in two. Symptoms may occur periodically and become worse during periods of increased fatigue or illness.

In newborns and infants, farsightedness, as well as slight intermittent strabismus present quite often. But since the disease disappears, after 4 - 5 months the eyes become even.

Treatment

Treating unstable convergent and divergent strabismus will be much easier if the process is started in a timely manner. Types of treatment are as follows: conservative (therapy) and surgical (surgery). The therapeutic method includes special exercises and involves complex and lengthy treatment. Strabismus, amblyopia and farsightedness can be successfully treated without surgery.

The main stages of strabismus treatment are:

examination to determine the cause of strabismus;
preliminary correction of visual acuity (glasses or contact lenses);
diploptic and orthoptic hardware treatment (restoration of binocularity);
elimination of amblyopia (amblyopia - lazy eye syndrome);
consolidation of the achieved effect.

Operation

Surgery will be appropriate only if the therapeutic method is completely ineffective. The most favorable period for carrying out such operations is the age of 4 - 5 years. A preschool child is able to adhere to all recommendations and perform the necessary orthoptic exercises.

Congenital paralytic strabismus in children with a large angle of deviation, especially vertical divergent - alternating, therefore surgical treatment of childhood strabismus is carried out at an earlier age.

Surgery to correct strabismus (surgical correction) involves two types of surgical solutions:

weakening of an overstrained extraocular muscle after its intersection or partial excision of the muscle;
strengthening of weakened muscles by excision with their further fixation.

Both methods in their pure form are rarely implemented, since in most cases the symptoms of the disease have to be treated in a combined way.

Depending on the complexity of the painting, the desired effect may not be achieved the first time. In this case, a repeat operation is prescribed, which is performed no earlier than 6 to 8 months later.

At the first stage of surgical treatment, the goal is to remove the cosmetic defect, that is, to cure convergent, divergent, and less often alternating concomitant strabismus, which traumatize the psyche of a child of any age, after which amblyopia, farsightedness and visual function are treated.

Sometimes, after surgical treatment of strabismus in children, acquired specific complication– hypercorrection. resulting from errors in calculations. By-effect develops not only immediately after surgery, but also a little later. In this case, the operation is repeated.

Gymnastics

To strengthen the eye motor muscles, experts recommend performing certain exercises:

raising your hand up with your index finger extended and, performing a vertical downward movement, lower it, bringing your finger closer to your nose, then repeat the same, but horizontally, moving your hand to the side;
“write” an eight with your eyes, make circular movements, then look up and down, left, right.

Games with a ball or shuttlecock will be very useful. Table and lawn tennis, football, volleyball help the child to follow the moving ball with his eyes, which constantly changes direction, approaches and moves away.

It will be useful for preschool and school-age children working at a computer. periodically look out the window, look at distant objects. After this, focusing your gaze on something nearby.

Similar exercises are performed daily for 10–15 repetitions, in the afternoon or after dinner. If you are not lazy and take the issue seriously, the proposed gymnastics will help cure the disease.

The result of strabismus treatment is not only a successful operation, but also perseverance, the desire to recover and, of course, regular daily exercise.

Prevention

There are a number of rules, the observance of which will help correct convergent strabismus in children, as well as preschool children and schoolchildren:

To avoid staring at one point, it is not recommended to hang a child of any age near the crib objects that attract attention. It is optimal if the crib has access from all or at least several sides;
To prevent farsightedness and imaginary strabismus, rattles in the stroller should hang at arm's length baby;
necessary ensure even load on the eyes child, after which the brain will be able to evenly process signals coming from outside;
A child’s acquaintance with television should take place at the age of no earlier than 3 years, with mandatory limiting screen time ;
It is not allowed to watch TV while lying down. To do this, you can put a pillow and take a semi-sitting position;
need to be carefully ensure correct posture. especially at your desk. Children who have poor posture have the habit of bending low over the table, which can result in amblyopia and farsightedness;
check and exclude literature with small print from the student’s library;
small pictures and fonts on the monitor unnecessarily overload the eye muscles, so Communication with a computer should begin no earlier than 8 years of age ;
in the presence of hereditary factor, regular examinations by an ophthalmologist- Necessarily;
if possible protect the child from stress and mental trauma .

If this is not an imaginary strabismus, you cannot let the course of the disease take its course. The sooner you start treating its symptoms and doing special exercises, the better.

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Often, strabismus surgery does not immediately return normal vision. Many will agree that it is a pity to look at a young, pretty girl or child looking askance. Without this cosmetic defect everything would be fine. In addition, ophthalmologists recommend trying conservative methods of treating strabismus before going under the knife.

What is strabismus, or strabismus?

Acquired strabismus occurs as a result of:

infectious disease: influenza, measles, scarlet fever, diphtheria, etc.;

somatic diseases;

injuries;

a sharp drop in vision in one eye;

myopia, farsightedness, high and moderate astigmatism;

stress or severe fear;

paresis or paralysis;

diseases of the central nervous system.

How can you get rid of strabismus?

Strabismus corrects:

wearing special glasses;

a series of eye exercises;

wearing a blindfold covering one eye;

surgery to correct strabismus.

Variable strabismus, when sometimes the right or left eye squints, is tried to be corrected by wearing a bandage. Long-term use of specially designed glasses often helps. Exercises to strengthen the ability to focus are recommended for almost all patients with strabismus. If all of the above methods do not correct vision, surgery is performed to correct strabismus. This type of surgery is performed both in infancy and in adulthood.

Types of surgeries to correct strabismus

The following types of strabismus occur in children and adults:

horizontal - converging and diverging relative to the bridge of the nose;

vertical;

combination of two types.

Doctors encounter convergent strabismus more often than divergent strabismus. Along with converging strabismus, the patient may have farsightedness. Myopic people usually have divergent strabismus.

During the operation the following can be performed:

amplification type surgery;

debilitating surgery.

In weakening surgery, the eye muscles are transplanted a little further from the cornea, which tilts the eyeball in the opposite direction.

In some clinics, the operation is performed under local anesthesia only for adults. and in others, all patients are given general anesthesia. Depending on age, health status and other factors, mask (laryngeal), endotracheal anesthesia using muscle relaxants, or an alternative type of anesthesia is performed.

After surgery, an adult can go home on the same day. The child needs preliminary hospitalization. Most often, mothers are in the hospital with their children; discharge occurs the next day after the operation. The recovery period takes about 14 days. After discharge, the patient extends the sick leave or certificate at his clinic.

Carrying out the operation

A few days before surgery, you need to take blood tests, do an ECG and undergo a consultation with some specialists. You should not eat 8 hours before surgery. If it is scheduled for the morning, you can have dinner, and if it is in the afternoon, then a light breakfast is allowed. The child and mother are admitted to the hospital a couple of days before the operation. The procedure is performed under general anesthesia. The operation itself lasts 30-40 minutes, then the patient is taken out of anesthesia and transferred to the ward. All this time, a bandage is placed on the eye. After the operated patient has completely recovered from anesthesia, he is examined by a surgeon in the afternoon. He opens the bandage, checks the eye, puts in special drops and closes it again. After this, adults are sent home with detailed recommendations: what medications to take, what to put in their eyes, and when to come for a second examination. The eye patch is left until the next morning. After a week, you need to come for an examination, where the doctor will assess the healing speed and condition of the eye. The final assessment of eye position is carried out after 2-3 months.

For several weeks after surgery, special anti-inflammatory drops and (if necessary) antihistamines are used. The eye will be red and swollen. Sometimes the next morning the eye will stick together due to accumulated pus. There is no need to be scared: it is washed with warm boiled water or sterile saline solution. For a couple of days the eyes will be very watery and sore, and it will also seem as if there are specks in the eye. The sutures dissolve on their own after 6 weeks.

For a month after surgery, you need to carefully protect your eye. You cannot swim, stay in dusty areas or play sports. Children at school are exempted from physical education for six months.

A month after the operation you need to undergo a course of treatment. To restore the binocular ability to see and recognize the correct picture, you need to undergo special hardware treatment at a medical center. Some clinics have the Amblicor complex, developed by specialists from the Brain Institute. Treatment using this device is a computer video training. It helps overcome the skill of suppressing vision in one eye. While watching a cartoon or movie, an EEG of the visual cortex of the brain and readings about eye function are continuously taken from the patient. If a person sees with both eyes, the film continues, and if only with one, it pauses. Thus, the brain is trained to perceive the image from both eyes.

Types of surgical intervention for strabismus

The main task of anyone surgical intervention with strabismus, one must consider recreating the correct balance between the eye muscles responsible for the movement of the eyeball.

During augmentation surgery, the eye muscle is shortened due to:

formation of a special fold at the site of the tendon (tenorrhaphy);

moving the muscle attachment point to eyeball(anteposition).

Relieving surgery to correct strabismus aims to relieve excess tension and weaken the eye muscle by:

changes in its place of attachment to the eyeball (recession);

its extension (plastic);

inefficiency non-surgical treatment carried out over a long period of time;

very strong degree of strabismus;

non-accommodative strabismus.

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Each of these periods has a huge impact on favorable outcome operations.

The operation itself involves highly technical manipulations by a competent ophthalmologist to establish the correct balance between the patient's eye muscles in order to restore symmetry in the placement of the eyes. The operation is performed using painkillers.

Postoperative recovery can take a different period of time in different patients. It lies in strict observance all recommendations of the attending physician for the elimination of:

eye discharge;

double vision, etc.

It is important to understand that to eliminate strabismus, the operation must be performed at a strictly defined time, determined by the doctor. You can't put it off, because... The level of vision may significantly decrease. We must not allow events to be forced, which would have a negative impact on its outcome. In some cases, surgery consists of several necessary steps.

After elimination of strabismus surgically Various complications may arise, the elimination of which will require additional treatment eye or repeat surgery. The main complications of this kind should be considered:

excessive vision correction;

Strabismus

Types of surgeries to correct strabismus

In general, there are two types of operations for strabismus. The first type of surgery is aimed at weakening the overly tense extraocular muscle. An example of such operations is recession (crossing a muscle at its insertion and moving it in such a way as to weaken its action), partial myotomy (partial excision of part of the muscle fibers), muscle plastic (for the purpose of lengthening). The second type of surgery is aimed at strengthening the action of the weakened extraocular muscle. An example of operations of the second type is resection (excision of a section of weakened muscle near the attachment site with subsequent fixation of the shortened muscle), tenorrhaphy (shortening of the muscle by forming a fold in the muscle tendon area), anteposition (moving the site of muscle fixation in order to enhance its action).

Often, during surgery to correct strabismus, a combination of the above types of surgical intervention (recession + resection) is used. If, after surgery, there is residual strabismus that is not leveled by self-correction, repeated surgery may be required, which is usually performed after 6 to 8 months.

To achieve maximum effectiveness when performing surgery to correct strabismus, you must adhere to several basic principles.

1. Unnecessarily speeding up the process of surgical correction of strabismus often leads to unsatisfactory results. Therefore, all manipulations should be carried out in doses (if necessary, in several stages).

2. If it is necessary to weaken or strengthen individual muscles, dosed surgical intervention should be distributed evenly.

3. When performing surgery on a specific muscle, it is necessary to maintain its connection with the eyeball.

High-tech strabismus surgery:

Specialists from children's eye clinics have developed modern high-tech radio wave surgery using the principles of mathematical modeling.

Advantages of high-tech eye surgery:

The operations are low-traumatic; thanks to the use of radio waves, the structures of the eye are preserved.
After the operations there is no terrible swelling, the patient is discharged from the hospital the next day.
Operations are precise.
Thanks to the principles of mathematical calculation, we can ensure the highest accuracy and show the guaranteed result of the operation even before it is carried out.
The rehabilitation period is reduced by 5-6 times.

Results of surgery for strabismus

Surgical treatment of strabismus allows you to correct a cosmetic defect, which is a strong traumatic factor for patients of any age. However, to restore visual functions (i.e., binocular vision) after surgery, an integrated approach is required, which includes pleoptic therapy (it is aimed at treating amblyopia accompanying strabismus) and orthoptodiploptic therapy (restoration of depth vision and binocular functions).

It should be mentioned that, like any operation, surgical correction of strabismus may be accompanied by the development of certain complications. One of the most common complications of strabismus surgery is excessive correction (so-called hypercorrection), caused by errors in calculations. Overcorrection may occur immediately after surgery, or may develop after some time. For example, if the operation was performed in childhood, then in adolescence, when the eye grows, the child may experience strabismus again. This complication is not irreparable and can be easily corrected with surgery.

The essence of the operation to correct strabismus

General provisions when performing operations for strabismus

Surgery to correct strabismus is often the only effective way to treat it. Strabismus is a disorder of binocular vision. in which, while looking straight, the position of one or both eyes may have various deviations to the sides. You can consider in more detail the types of operations performed for strabismus, general provisions their implementation, possible consequences

and results.

There are 2 types of operations for strabismus:
enhancing;
weakening.
excision of some portion of it (resection);

excision of part of the muscle fibers (partial myotomy).

Surgical intervention, depending on the situation, can be performed on one or simultaneously on both eyes; any combination of the above types can be used. In some cases, repeat surgery is required. The issue of surgical intervention is decided by an ophthalmologist after he has established the causes of the specified visual impairment and carried out full diagnostics

eye. The following factors may serve as indications for surgery to eliminate strabismus:

paralytic strabismus;

It is important to remember that from a cosmetic point of view, these operations can eliminate strabismus completely, but binocular vision is not always restored.

General provisions when performing operations for strabismus

The general scheme of surgical intervention is as follows:
preoperative preparation;
the actual operation;

Preoperative preparation can last up to 1 year. Its goal is to rid the brain of the habit of perceiving an incorrect image. For this purpose, various electrical stimulation techniques can be used, which are prescribed by the doctor depending on the individual characteristics of each patient.

redness of the eyes;
discomfort and pain with sudden movements, in bright lighting;
various inflammatory processes in the operated areas.

The cosmetic effect after a correctly performed operation to correct strabismus will be visible immediately, vision restoration will occur in 1-2 weeks. In some cases, orthoptodiploptic and pleoptic therapies will be required to restore the binocular functions of the eyes and depth vision.

Thus, surgery to eliminate strabismus in most cases can restore normal vision and correct a cosmetic eye defect, thereby returning the patient to a full life.

Treatment of strabismus and its complications

Since strabismus develops against the background of other pathological conditions of the organ of vision, and symptoms are detected when the disease has already developed, then, quite often, regular contact with an ophthalmologist allows you to avoid the occurrence of strabismus itself and the complications accompanying it.

Treatment of strabismus begins from the moment the diagnosis is established and the underlying disease that resulted in it is eliminated. After eliminating the root cause, patients with strabismus undergo complex multi-stage treatment.

Optical correction

At the first stage, the cause of strabismus is determined, and conditions are created for normal visual work. If a refractive error is detected, its correction is prescribed with correctly selected glasses or contact lenses, which are selected after many days of cycloplegia using an atropine solution in an age-specific concentration. This procedure necessary to identify the hidden part of farsightedness or eliminate the false part of myopia created by tension in the ciliary muscle, which is responsible for clear near vision (spasm of accommodation).

Pleoptic treatment of strabismus

Pleoptic treatment of strabismus includes a whole range of measures, the purpose of which is to increase and level the visual acuity of both eyes to the age norm. If functional vision loss (amblyopia) is present or more pronounced in one eye, then occlusion (exclusion from visual work by gluing) is prescribed to the better-seeing eye. With constant strabismus, the occlusion mode is alternating, the worse-seeing eye is glued for one day, and the better-seeing eye is glued for two or more, depending on the difference in visual acuity. Treatment of amblyopia is a difficult and lengthy process, to speed it up using different kinds retinal stimulation. At home, these are flash exposures, perifoveal penalization, and training of accommodation reserves. In the conditions of the ophthalmology department, this group of patients can undergo more effective ways- computer techniques, laser stimulation. electrical stimulation. magnetic stimulation. pattern stimulation, color therapy, in case of incorrect fixation - maculotester, monocular spatial reorientation using Küppers lights on a non-reflex ophthalmoscope.

Preoperative orthoptic treatment

Preoperative orthoptic treatment of strabismus begins after achieving relative equality of vision in both eyes. A symmetrical position of the eyes is possible only if the correct spatial perception of objects by each eye and the creation of a single visual image by the brain by combining the images received from each eye. Surgical correction of strabismus leads to an orthophoric position of the eyeballs in the orbit, but for correct image perception, the patient must have binocular vision before surgery. Firstly, before curing strabismus, alternating occlusion is strictly necessary. This avoids the occurrence in the brain pathological mechanisms combating double vision: functional scotoma suppression and abnormal correspondence of the retina. They start with the simplest thing - creating consistent visual images using Chermak lighting, as well as using special devices. When treating with a synoptophore, visible objects are placed in eyepieces, which are set at an angle equal to the angle of strabismus. Therefore, a patient with strabismus perceives what he sees as a person with an even eye position. During classes on the four-point color test or when fixing a light source through Bagolini glasses, asymmetry of the visual axes is corrected by prisms, prism compensators or elastic Fresnel prisms. At this stage of treatment, the ability to turn on binocular vision is formed when looking sideways, from one object to another, thus developing fusion reserves.

Surgical correction of strabismus

Surgical correction of strabismus is carried out only if the pleopto-orthopto-diploptic treatment of concomitant strabismus is insufficiently effective. Surgical correction of strabismus in children is best performed at the age of 3-4 years, when the child has developed the ability to include binocular vision. Early surgical correction of strabismus in children without preliminary orthoptic exercises is indicated mainly for large angles of eye deviation in congenital strabismus. In adult patients, surgery to correct strabismus can be performed at any time, depending on the patient’s wishes.

Surgery to correct strabismus in paralytic strabismus. In case of paralytic strabismus, the indications and timing of surgical treatment are determined only together with the relevant specialists (neurologist, oncologist, infectious disease specialist).

Surgical correction of strabismus can have several goals:

reduction of the strabismus angle before pleoptic or orthoptic treatment,
preventing the development of contracture of the external muscles of the eye with a large amount of strabismus,
for the purpose of functional cure for strabismus,
With for cosmetic purposes if it is impossible to improve vision or teach correct binocular vision.

Surgical correction of strabismus is performed by performing two types of operations: strengthening or weakening of the eye muscles. Technically, there are many methods of surgical dosed intervention. In order to weaken the muscle, recession (moving away), partial myotomy (incomplete dissection of the muscle), tenomyoplasty (muscle lengthening) are performed, and to strengthen it, resection (shortening) of the muscle-tendon part and prorrhaphy (moving the muscle anteriorly) are performed.

Classically, with recession (weakening surgery), the attachment site of the muscle changes, it is transplanted further from the cornea; with resection (strengthening surgery), the muscle is shortened by removing part of it, the attachment location of the muscle to the eyeball remains the same. The extent of the operation to correct strabismus is determined by the size of the strabismus angle. The correct position of the eyes can be restored in the vast majority of cases. The remaining eye deviation after surgery can be subsequently eliminated with the help of orthopto-diploptic treatment. When indicated, a combined surgical correction of strabismus is performed, when one muscle is simultaneously weakened and another muscle is strengthened in one and then the other eye.

Postoperative orthoptic treatment

Postoperative treatment of strabismus involves the same principles as preoperative treatment and is aimed at restoring and developing binocular vision.

At this stage, the symmetrical position of the eyes achieved after the operation is consolidated. The child’s ability to see binocularly improves, fusion reserves expand, and physiological double vision is formed, which is necessary for correct perception of the distance to an object.

Treatment of strabismus is a long process that requires a lot of patience from you, strict adherence to the doctor’s recommendations, and an understanding of the stages of treatment. The sooner the pathology is identified and treatment of strabismus is started, the higher the likelihood of your full functional recovery.

Surgical treatment of nystagmus

Surgical treatment of nystagmus involves changing the tone of the horizontal muscles in order to move the position of “relative rest” to the midline position. The operation is performed strictly symmetrically on both eyes and in two stages. At the first stage, bilateral recession of the muscles associated with the slow phase of nystagmus is performed. The second stage of the operation consists of bilateral resection of the muscles responsible for the fast phase of nystagmus. It is advisable to carry out this stage after the result of the first operation is determined and the nystagmus acquires a stable jerky character. If after the first stage of the operation the nystagmus is eliminated or sharply reduced, the second stage is not resorted to.

In conclusion, it must be emphasized that surgical treatment of pathology of the oculomotor system (strabismus, nystagmus) is extremely rarely accompanied by complications, and, as a rule, brings a sense of great satisfaction to both the ophthalmic surgeon and the patient.

There are certain problems of the oculomotor system in which the changes leading to the alignment of the eyes during the healing period [after surgery] are quite predictable. For example, when a child undergoes surgery to correct exotropia(divergent strabismus), during the healing period the eyes tend to diverge ( divergence) by an average of 5 degrees. For this reason, for the ideal alignment of the eyes [in the future], in some children immediately after correction surgery exotropia the eyes should be “over-corrected” by a few degrees (they look like exotropic, or squinting inward), so that when the eyes open a little during healing, they will become straight. In a person suffering exotropia, the brain is accustomed to divergent eyes ( divergent), and he learned suppress[image of] a deviating eye. He is not used to inward-turned eyes (convergent squint) and “doesn’t know how to suppress” a squinting eye. Consequently, when the eye is turned inward after such surgery, temporary double vision is common and is common. Typically this lasts several days or weeks. If double vision does not go away, it may need to be treated with eye drops, glasses, prisms or another operation. In most cases, temporary double vision after surgery for strabismus is predictable and there should be no cause for concern or alarm about it.

Question: My daughter's exotropia. When she looks at me, I see that only her left eye is off center, and I have never seen her have any problems with her right eye. Her doctor wants to perform surgery on both eyes. Why?

Answer: Your doctor's recommendation may be entirely appropriate. Don't think about divergent strabismus Your daughter seems to have a problem only in her left eye. Imagine that both of her eyes are not looking in the same direction, but are moving apart. But when she looks at you, she should use either her right eye or her left. Otherwise, she won't look at you. If her right eye is dominant (same as yours) right hand may be more coordinated than the left [if you are right-handed]), then given a choice, it always chooses to look with the right eye. Consequently, you constantly see only your left eye as deviating. All you have to do is evaluate her gaze with your left eye (perhaps while covering her right eye), and you may very well see that the right eye deviates as far from center as the left (see again (see Figure 6-2 on page 59). You will never see the left eye deviate on its own because she does not look with the left eye if there is a choice of one eye or the other.

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Strabismus, heterotropia, or strabismus is a malfunction in binocular vision when improper coordination of the eyes on the object in question occurs. One or two eyes deviate from the center of the visual axis in the direction of the nose or temple, as a result of which the fixation of the eyes on the object is disrupted. If no correction methods help, surgery eliminates strabismus.

Definition of strabismus and methods of correction

Strabismus is considered to be a childhood disease, since it manifests itself in childhood. The occurrence of strabismus in adults is much less common, and is often caused by a disruption in the functioning of nerve connections. There are many reasons that contribute to the occurrence of strabismus:

Traumatic brain injuries;
Genetic predisposition;
Psychological herbs;
Poor blood circulation to the brain;
Infectious diseases of the brain;
Incorrect treatment of myopia and farsightedness;
Excessive strain on the eyes;
Disruption of the extraocular muscles.

Testing strabismus covers a holistic analysis of the organs of vision - the work and location of the muscles, the fundus and visual acuity, the angle of strabismus and the age of the patient are assessed. If strabismus is present, surgery is not immediately prescribed; they first try to eliminate it without surgery. Treatment has three subsequent stages:

Optical correction;
Pleoptic treatment;
Orthoptic treatment.

Optical correction is treatment through properly selected glasses and lenses to create optimal conditions for the functioning of the eyes. If there accompanying illnesses(myopia, farsightedness, astigmatism, infections) then their treatment is carried out on at this stage therapy.

Pleoptic treatment is aimed at increasing and equalizing the acuity of both eyes to age-related norms.

Orthoptic treatment is essentially a preoperative stage. It is advisable to carry it out only after relative equality has been created visual acuity between the eyes. Its goal is to develop in the patient the ability to turn on binocular vision (the ability to clearly see an object with both eyes) when looking away in different directions. In the absence of binocular vision, the question of prohibiting the operation may arise. Eye symmetry is possible only with the same spatial perception objects, objects with both eyes.

It is prescribed only when the maximum possibility of visual functions has been achieved in both eyes.

Squint surgery

All operations aimed at correcting strabismus involve correcting the work of the extraocular muscles - strengthening and weakening. Manipulations are carried out only as part of traditional surgery; laser correction of strabismus is not practiced. Surgical treatment of strabismus involves cutting the muscle, but this cannot be done with a laser.

The goal of strabismus surgery is to restore muscle balance and binocular vision. But often it is possible to improve only cosmetic defects; restoration of visual functions after surgery requires integrated approach and active conservative therapy. In ophthalmology, there are three areas of surgical correction of strabismus:

Relieving muscle cravings;
Strengthening traction;
Changing directions of muscle action.

Muscles that weaken cravings include:

Recession, which implies a surgical intervention that results in a laxative effect of muscle traction, achieved by shifting the site of muscle attachment to the beginning of the muscle.
Myectomy is a procedure to remove a specific muscle from its insertion site. The main indication for such an operation is muscle hypercontraction.
Posterior fixing sutures - a procedure consisting of recession with sequential suturing of the belly of the moved muscle to the sclera, slightly behind the place of its attachment.

Aimed at restoring weakened extraocular muscles:

Resection is the process of excision of a certain area of weakened muscle at the site of its attachment, followed by its fixation. Essentially, the remaining sections are stitched together.
Tenorrhaphy is the process of shortening a muscle by creating a fold in the muscle tendon area. As a result, the shortened muscle is significantly enhanced in terms of contractile function.
Anteposition is the process of changing (transporting) the place of muscle attachment.

Advantages of surgical ophthalmology:

Low trauma;
The structure of the eye is preserved;
Precision of operation;
Small % of consequences;
High guarantee of good results;
A short rehabilitation period.

Surgical intervention to eliminate strabismus does not provide a 100% guarantee of complete correction, but the chances are high - up to 80%. If strabismus persists after the procedure, the operation can be performed again after six months. You should not expect that you will see “correctly” immediately after surgery. During the time that a person suffered from strabismus, the brain lost the habit, forgot how to compare the visions from both eyes into one image, and it will take a lot of time for it to learn. Like any operation, complications may arise. First of all, these are calculation errors that lead to repeated strabismus.

Squint surgery is performed under complete or local anesthesia(according to indications) on an outpatient basis, hospitalization is not required - a few hours after the operation the patient is sent home. Ophthalmological operations, like all others, are performed on an empty stomach. Everything is taken in advance necessary tests. During the procedure, the patient must be absolutely healthy (no ARVI, fever, infections). The procedure on average does not exceed 30 minutes. After the operation, the patient is given a special bandage, which is left for 12-24 hours. The sutures are applied give sensation foreign object in the eye, they do not need to be removed, they dissolve within 6 weeks after application. After surgery, the patient needs to use anti-inflammatory drops. If suppuration occurs, rinsing will be indicated.

The following steps must be taken:

Carefully protect the eye from contamination;
Do not engage in physical labor for the first three weeks after surgery;
Do not swim in public places;
Do not disturb the eye, do not rub it.

After surgery, careful monitoring of the eye is required. It is necessary to regularly visit an ophthalmologist, use necessary medications and rest your eyes. To restore muscles, a special system of exercises is being developed that must be performed. The assessment of eye position is checked no earlier than two months after surgery.

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Since the disease occurs due to an imbalance of the extraocular muscles, the purpose of the operation is to strengthen or weaken them. Surgery is performed if there are serious complications or if other vision correction methods are ineffective.

Indications and contraindications

The essence of the operation for strabismus is to strengthen weak muscles by shortening them, as well as lengthening short fibers. During surgery, all 6 extraocular muscles, which hold the eye in its natural position, are affected.

It is most effective to treat strabismus in childhood (5-6 years), when the child can perform orthoptic exercises. In case of a congenital disease, if the angle of curvature is more than 45˚, the operation is performed much earlier, at 2-3 years.

In children, surgery to eliminate strabismus is performed less frequently, since this disease is easier to cure in a child than in an adult.

Indications:

correction of a cosmetic defect;
severe strabismus;
paralysis of the extraocular muscle;
strabismus caused by trauma;
ineffectiveness of other techniques to improve binocular vision, e.g. laser correction strabismus;
double vision.

Contraindications to surgical treatment may be the individual characteristics of the patient. Usage general anesthesia contraindicated in serious illnesses any organ, stroke, as well as allergies to anesthetics.

Kinds

For strabismus, several types of surgical intervention are possible. When relaxing a tense muscle:

Recession. This is cutting off the tissue at the site of its attachment and suturing it to the sclera, after which the muscle relaxes.
Partial myopia. This is the excision of part of the muscle tissue.
Muscle plasticity, that is, its lengthening.

When strengthening a weak extraocular muscle:

Resection. This is shortening the muscle, followed by fixation to enhance its action.
Tenorrhaphy. This is the formation of a fold inside a muscle or in the muscle tendon area.
Anteposition. This is a movement of the muscle fixation site.
Operation Faden. This is suturing the muscle with non-absorbable threads.

Sometimes correction of strabismus requires the simultaneous use of recession and resection.

The surgeon decides on the choice of method while the patient lies on the operating table. The type depends on the angle of strabismus, the age of the person, the location of the extraocular muscle, and the condition of the eye.

Stages of implementation

Surgery for strabismus in adults is performed under local anesthesia. The patient does not need hospitalization and can return home on the same day. The procedure lasts 30 minutes.

In children, surgery is performed under general anesthesia.

Before the operation, preparation is important, which can last up to 6 months.

The preparatory period involves alternately opening and closing the eyes. The operation to correct strabismus goes like this:

The eye is fixed in one position and an eyelid speculum is inserted.
The sclera and conjunctiva are cut to gain access to the muscles. At this moment the eye becomes wet.
The muscle is pulled out through the incision. Depending on the problem, it is sutured or cut off from the fixation site.
Stitches are applied.

If the deviation angle is more than 45˚ in children under 5 years of age, surgical intervention is carried out in 2-3 stages. First you need to reduce the angle of strabismus, and final correction is possible from 4 years of age.

If after the operation strabismus remains, which is not eliminated by self-correction, then repeated surgery is necessary. It is carried out no earlier than after 6-8 months.

Postoperative period

In the first few days after surgery, the eye will hurt, and double vision may appear.

Vision restoration occurs within 4 weeks. During this period, it is important to teach the eye to see correctly, so after surgery it is necessary to perform orthoptic exercises for 1-2 weeks. You also need to take the drops prescribed by your ophthalmologist.

To teach the operated eye to see, you need to cover the healthy one with a bandage. May be required to wear.

In children, recovery occurs faster.

Complications

The following complications may occur after surgery:

Hypercorrection. This complication occurs if the operation was performed in childhood, then strabismus may appear again in adolescence.
Damage vagus nerve, which is responsible for the functioning of the heart, lungs and gastrointestinal tract. This consequence can even lead to death.
The appearance of scars, which makes it difficult to move the eye.
Re-development of strabismus. This happens if after surgery the patient does not follow the doctor’s recommendations.

Price

In the presence of compulsory medical insurance policy this type of surgical intervention public clinics absolutely free. In private ophthalmological centers You will have to pay up to 20 thousand rubles for treatment.

Surgical treatment for strabismus is carried out as a last resort. There are other, more gentle methods of vision correction.

Surgery to correct strabismus caused a sharp decline in vision. Recovery after strabismus surgery

Types of surgeries to correct strabismus

High-tech strabismus surgery:

Results of surgery for strabismus

surgeries that weaken muscle action

Chemodenervation with botulinum toxin for strabismus

Eye surgery to correct strabismus

What is strabismus, or strabismus?

How can you get rid of strabismus?

Types of surgeries to correct strabismus

Carrying out the operation

Strabismus in children

Causes

Symptoms

Treatment

Operation

Gymnastics

Prevention

What is strabismus, or strabismus?

How can you get rid of strabismus?

Types of surgeries to correct strabismus

Carrying out the operation

Types of surgical intervention for strabismus

Strabismus

Types of surgeries to correct strabismus

High-tech strabismus surgery:

Results of surgery for strabismus

The essence of the operation to correct strabismus

It is important to remember that from a cosmetic point of view, these operations can eliminate strabismus completely, but binocular vision is not always restored.

Treatment of strabismus and its complications

Optical correction

Pleoptic treatment of strabismus

Preoperative orthoptic treatment

Surgical correction of strabismus

Postoperative orthoptic treatment

Surgical treatment of nystagmus

Definition of strabismus and methods of correction

Squint surgery

By secret

Indications and contraindications

Kinds

Stages of implementation

Postoperative period

Complications

Price

Useful video about surgical treatment of strabismus

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