Condition after surgery for strabismus. Strabismus after surgery surgery and strabismus vision correction. Postoperative period and complications

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 that 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 injury;
• the ineffectiveness of other techniques for improving binocular vision, such as laser correction of strabismus;
• double vision.

Contraindications to surgical treatment may be the individual characteristics of the patient. The use of general anesthesia is contraindicated in case of severe diseases of any organ, stroke, or allergies to the anesthetic.

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:

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

If you have a compulsory medical insurance policy, this type of surgical intervention in public clinics is 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.

Useful video about surgical treatment of strabismus

Although strabismus is usually found in preschool children, some adults also suffer from this condition. Strabismus is a lesion in which the visual axis of one eye deviates from the joint point of fixation. Visually, it looks as if a person’s eyes are looking in different directions. Conservative therapy provides improvements only if the deviation is detected in time. In other cases, only surgical intervention will help correct the situation. How effective is the correction of strabismus in adults, prices for which vary from 35,000 to 40,000 rubles, and in what ways is the correction carried out?

Reasons for the development of strabismus

Before trying to figure out what triggered the development of strabismus, it is necessary to identify what form of lesion the person is faced with. Strabismus can be congenital or acquired. Each form develops for different reasons.

Congenital strabismus is quite rare and is often detected immediately after the baby is born. But experts warn that such a violation is often “false.” Due to weak muscle fibers, some children cannot focus their eyes on their own. At the same time, it seems that the child is developing a pathology. As for true congenital strabismus, the disease can develop against the background of infantile central palsy or Down syndrome. The disorder may also be caused by a genetic predisposition. Pathology often develops if during pregnancy a woman suffered from infectious diseases and took potent medications on an ongoing basis.

The acquired form of strabismus also more often manifests itself before 12 months, but there are often cases when the pathology makes itself felt at an older age. Most often, the role of a provoking factor is:

In adults, strabismus often develops as a complication after a severe flu. But this is only possible if a person has a predisposition to pathology since childhood.

If an adult patient is diagnosed with a severe form of strabismus, the situation can only be corrected through surgery. Conservative methods are effective only in the initial stages. Most experts recommend performing surgery to correct strabismus in several stages. This is due to the fact that surgery on more than 2 muscles at a time can be dangerous and increases the risk of complications.

Lengthening or shortening of the affected muscles is always carried out evenly on both sides. The dimensions of the excisions should also be identical. If there are indications for an intervention, the patient needs to be very careful when choosing a clinic and surgeon, since the result largely depends on the experience and qualifications of the physician.

If financial capabilities allow, it is better to perform an operation to eliminate the pathology from German and Israeli specialists. In these countries, the technology for correcting ocular muscle fibers is more advanced, making it possible to eliminate the disease in one go.

Is the operation dangerous?

The eyes are one of the most vulnerable organs, so any ophthalmic surgery involves certain risks. As medical practice shows, the most common complication after eliminating strabismus is the appearance of a double image. In more than 70% of cases, this deviation disappears on its own some time after the operation, but sometimes the complication remains.

It is also worth considering that the course of the operation and the further condition of the patient largely depend on the initial state of health of the person. The younger and healthier the patient, the faster the recovery will be and the lower the risk of developing postoperative complications. If the operation is performed in a modern clinic with high-quality equipment under the supervision of an experienced doctor, the risk of negative consequences will be minimized.

Indications for use

Surgery to correct strabismus is usually prescribed if:

• the patient was prescribed various methods of conservative treatment of strabismus, but they did not bring positive changes or the improvements were insignificant;
• The patient wants to get rid of strabismus as soon as possible. If conservative therapy usually lasts 2-4 years, then surgery will help eliminate the defect in just a couple of months (along with the rehabilitation period);
• The patient was diagnosed with a strong stage of strabismus. In advanced cases, doctors advise first to undergo surgery, and only after that they prescribe conservative treatment methods. Most often they are used to consolidate the achieved result.

Before the operation, the patient must undergo a full examination and make sure there are no contraindications, since some individual characteristics are a limitation to such a correction.

Types of surgery

The main task of eliminating strabismus in adults is to change the incorrect position of the eyeballs in the visual apparatus. The correction method is selected individually for each patient. The doctor takes into account the initial condition of the person and the degree of damage. Also, the technique is selected taking into account what exactly needs to be done - weaken or strengthen the muscles.

Correction of strabismus in adults, the purpose of which is to strengthen muscle fibers, is carried out in one of the following ways:

• resection – shortening of the affected muscle with further fixation;
• proraphy - strengthening of a muscle by displacing the tendon forward or backward;
• Tenorrhaphy - the formation of a small fold of tendons. This operation is performed so that a person can see better.

Today, the most popular method of strengthening the eye muscles is resection. This is due to the fact that other methods of correcting strabismus are more aimed at correcting the oblique muscles of the eyes.

If it is necessary to weaken the muscles, the surgeon disconnects them and fixes them away from the cornea. This operation is carried out using the following methods:

During the initial consultation, many patients are interested in whether it is possible to correct strabismus using laser correction. It is worth considering that laser techniques are used only to correct visual acuity, but it is impossible to change the position of the eyes using it.

Postoperative period and complications

Since the operation to eliminate strabismus is performed on an outpatient basis, the patient does not even have to go to the clinic for it. In most cases, a person is allowed to go home within a few hours after surgery. The patient is left in the hospital only if there are certain health problems or postoperative complications occur.

The postoperative period is usually no more than a week, but the speed of vision recovery largely depends on the body itself. 4-6 hours after surgery, a person may experience severe discomfort and the sensation of a foreign object in the eyes, and minor headaches. Such symptoms usually persist for 3-4 days, after which the condition begins to normalize and the person can return to normal life. To minimize the risk of complications, the patient should avoid active rest and heavy physical activity during the first time after surgery.

Full recovery usually takes 4 to 5 weeks. To speed up the regeneration process, you need to use special ointments and gels prescribed by your doctor. It is also useful to do eye exercises during the postoperative period.

As for complications, after surgery to eliminate strabismus they are quite rare and are more often due to negligence or medical errors. The most common complication is overcorrection. Pathology develops when the eye muscles are excessively lengthened or sutured. Such a violation occurs due to the following reasons:

• medical error;
• incorrect initial calculations.

To minimize the risk of complications, today operations are more often performed not with cutting, but with sewing in muscles. This technique allows you to adjust the applied suture. If the patient experiences undesirable consequences, they can be eliminated using a minimally invasive method.

The patient may also encounter the following pathologies:

• formation of a scar in the area of ​​excision of muscle fibers. The pathology is dangerous because it causes the muscle to lose its elasticity and mobility, and in its place fibrous tissue begins to form;
• secondary strabismus. Usually occurs if the patient ignores medical recommendations during the recovery period;
• injury to the vagus nerve during surgery. This injury is very dangerous, since the vagus nerve is responsible for the functioning of the myocardium, lungs and gastrointestinal tract.

Cost of the operation

The price of surgical correction of strabismus depends on the type of medical institution, as well as on the chosen technique. If a person goes to a municipal hospital, the procedure will be performed free of charge. The service is provided for patients of all ages, regardless of the form and stage of the lesion. In private clinics, the cost of the service depends on the complexity of the operation. The average cost of such an intervention in Moscow and other large cities of Russia is 38,000 rubles.

For strabismus treatment to be effective, you need to be very careful when choosing a clinic and surgeon. Also, success largely depends on how the rehabilitation period went. To minimize the development of complications and consolidate the result, the patient must strictly follow all medical recommendations and regularly undergo preventive examinations by an ophthalmologist.

An effective remedy for restoring vision without surgery or doctors, recommended by our readers!

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 are concomitant diseases (myopia, farsightedness, astigmatism, infections), then their treatment is carried out at this stage of 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 of visual acuity between the eyes has been created. 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. Symmetry of the eyes is possible only with the same spatial perception of objects and objects by 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 an 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 are 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.

Strabismus surgery is performed under full or local anesthesia (as indicated) on an outpatient basis, no hospital is required - the patient is sent home a few hours after the operation. Ophthalmological operations, like all others, are performed on an empty stomach. All necessary tests are taken in advance. 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 applied give the sensation of a 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 the necessary medications and rest the 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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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?

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:

How can you get rid of strabismus?

Strabismus corrects:

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:

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:

In weakening surgery, the eye muscles are transplanted a little further from the cornea, which tilts 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. The recovery period takes about 14 days. After discharge, the patient extends the sick leave or certificate at his 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 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 speed of healing and the 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 any surgical intervention for strabismus should be considered to be the restoration of the correct balance between the eye muscles responsible for the movement of the eyeball.

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

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

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Each of these periods is of great importance for the favorable outcome of the operation.

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 consists of strict adherence to all recommendations of the attending physician for the elimination of:

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 surgical removal of strabismus, various complications may arise, the elimination of which will require additional eye treatment or repeated surgery. The main complications of this kind should be considered:

Strabismus

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 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:

1. The operations are low-traumatic; thanks to the use of radio waves, the structures of the eye are preserved.
2. After the operations there is no terrible swelling, the patient is discharged from the hospital the next day.
3. Operations are precise.
4. 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.
5. 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 is a unique way to effectively help the patient.

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).

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 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.

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 essence of the operation to correct strabismus

6. 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, the general provisions for 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 a complete diagnosis of the eyes. 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 completely eliminate strabismus, 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;
• postoperative recovery.

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 from 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 functioning. 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 is 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 sealed 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 accelerate which various types of retinal stimulation are used. 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 be treated with more effective methods - 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 of pathological mechanisms in the brain to combat double vision: functional scotoma of 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 serve several purposes:

• 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,
• for cosmetic purposes when it is impossible to improve vision or teach correct binocular vision.

Surgical correction of strabismus is performed through 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 earlier 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.

Due to the fact that the eye does not work correctly, over time it can lose its main function forever, because the brain excludes this eye from the vision process, and after a while the visual skill disappears, after which it is almost impossible to restore it.

The most effective treatment method is surgery. This allows you to quickly and without consequences get rid of strabismus; operated patients often go home on the same day, and return to work or school on the third day after surgery.

However, surgical treatment of strabismus involves subsequent long-term rehabilitation, during which you may have to take strengthening medications and perform daily exercises for the visual organs.

Etiology of the disease

Strabismus is the absence of a parallel position of the eyeballs when looking at objects located in the distance. With the parallel position of the eyes and coordinated movements of the eyeballs towards the objects in question, images from the retina of each eye merge in the visual center of the brain into a single three-dimensional image.

This type of vision is called binocular and is characteristic of most people. If one of the eyes is in an “incorrect” position, when during distance vision the axis of one eye is shifted to the temple or to the nose, image fusion does not occur.

The brain perceives the “picture” of one eye, and the information from the second eye is “extinguished”; this type of vision is called monocular. There is a gradual deterioration in the vision of the squinting eye - amblyopia (colloquially “lazy eye”).

The cause of the disease is a violation of the synchronous functioning of the eye muscles and, as a result, one eye moves to the side. The occurrence of strabismus is influenced by:

1. absence of glasses or contact lenses with a high degree of development of farsightedness, myopia or astigmatism
2. stress, trauma, diseases of the central nervous system
3. abnormal development of eye muscles
4. sudden loss of vision in one eye
5. infectious diseases.

Two main types of strabismus:

• concomitant strabismus (characterized by preservation of the full range of eye movements)
• paralytic strabismus (there is a restriction in the movement of one or two eyes in any direction)

Types of concomitant strabismus:

1. congenital (9-10% of patients) / acquired strabismus (90-91% of patients)
2. periodic / constant
3. unilateral / intermittent
4. divergent and convergent strabismus (with divergent strabismus the eyes are turned towards the temple, with convergent strabismus - towards the nose) / vertical strabismus (deviation down or up)

The sooner the correct diagnosis is made and treatment of strabismus begins, the better the result will be, the likelihood of achieving straight eyes and maintaining high vision increases. Strabismus in children under three to four months is considered physiological, because muscular balance has not yet been established.

If after this age the strabismus does not go away, then you should definitely contact a pediatric ophthalmologist, who will check whether there are any reasons for the development of strabismus (farsightedness, myopia, astigmatism).

Taking into account individual characteristics, the pediatric ophthalmologist selects a complex of hardware treatment aimed at eliminating amblyopia, increasing visual acuity, restoring the correct position of the eyes and binocular vision.

There are different treatments for strabismus. Treatment of childhood strabismus should begin immediately from the moment the disease is identified. Hardware treatment of strabismus includes two groups of methods:

• Pleoptic treatment is a system of methods aimed at treating amblyopia:
  1. light-color stimulation (pattern stimulation) – based on stimulation of eye functions with a light flux concentrated in a narrow spectral range
  2. laser treatment (retinal laser stimulation)
  3. magnetic stimulation (improving blood supply to the eyes)
  4. electrical stimulation (improving hemodynamics, activation of metabolic processes, increasing the energy potential of tissues)
• Orthoptic treatment:
  1. liquid crystal glasses (alternating stimulation of both eyes, promotes the development of the motor fixation reflex, increased visual acuity and the development of binocular function)
  2. The binarimeter is a new generation device that allows you to form binocular vision in natural conditions
  3. computer methods for strengthening binocular function and increasing visual acuity
  4. training of weakened accommodative function

In some cases, in addition to hardware treatment, surgical intervention may be performed to achieve the correct position of the eyes. If the angle of strabismus is large, then surgical treatment is carried out in two stages.

The favorable age for surgical treatment in children is 4-6 years (before entering school). Strabismus in adults is much more difficult to treat.

Treatment of concomitant strabismus begins with the appointment of the correct optical or laser correction. Glasses, contact lenses or surgery help improve visual acuity and, by restoring normal eye function, help reduce the angle of strabismus.

In some cases, when the vision of the squinting eye decreases, especially in children, it is prescribed to “turn off” the non-squinting healthy eye (direct occlusion - sticker) so that the squinting eye is included in the act of vision.

Causes of the disease

According to the pathogenetic mechanism, a distinction is made between concomitant and paralytic strabismus. With concomitant strabismus, the angle of deviation of the affected eye from the point of fixation corresponds to the angle by which the healthy eye deviates if the patient is asked to “turn on” the squinting one.

Characteristic features of vision with strabismus

With this pathology, eye mobility is fully preserved; double vision does not occur (the image from a squinting eye is simply “discarded” by the brain at the processing stage). Most often it occurs against the background of ametropia (refractive error), in particular in people with farsightedness.

Other reasons:

1. anisometropia (difference in refractive power of the eyes) over 3 diopters);
2. a sharp decrease in vision of one eye, including against the background of a decrease in the transparency of the natural “lenses” of the eye - the cornea, lens, vitreous body;
3. retinal dysfunction, optic nerve diseases;
4. neurological diseases;
5. congenital anomalies.

Paralytic strabismus is associated with dysfunction of any extraocular muscle or the nerve that innervates it. The main differences of this form of the disease:

• restriction or absence of eye movement towards the affected muscle;
• lack of binocular vision and diplopia (double vision);
• the difference between the primary and secondary angle of strabismus - the squinting eye deviates from the point of fixation less than the healthy one, when trying to give the correct position to the eye, which moves the affected muscle.

The causes of the disorder range from a birth defect to an inflammatory process, a neurological disease, injury or poisoning. Sometimes, diabetes mellitus debuts with paralytic strabismus, so the examination of patients with strabismus is always comprehensive and exhaustive.

Hardware diagnostics of strabismus

Surgical treatment of strabismus is carried out in two ways, depending on the cause that provoked this deviation. If weakened muscles of the visual organs are identified, tenorraphy, anteposition, resection or the “Faden” procedure are indicated.

If axis deviations were caused by overstrain of the muscles of the visual organs, recession, plastic surgery/removal of the extraocular muscle, or partial myotomy is performed. Before the operation, the patient is prepared, including:

1. laboratory tests;
2. consultation of highly specialized specialists and other studies as directed by the attending physician.

If a patient is indicated for surgery on both eyes, a staged intervention is recommended with an interval of several months. To obtain successful results, experienced surgeons calculate the size of muscle areas in advance.

If significant strabismus is detected, it is not recommended to carry out restorative correction on more than two eye muscles at the same time. Shortening or enlarging is carried out evenly on each side.

It is very important to maintain the natural connection of the eye with the corrected muscle, so as not to provoke unpleasant consequences that affect the level of visual activity. That is why operations of this kind are best carried out in clinics with good reviews, modern equipment and a staff of experienced specialists.

Why treat strabismus?

There is an opinion that strabismus can go away on its own - this is a serious misconception. If treatment is not started in time, serious complications may develop. If you notice the first signs of strabismus, you should immediately consult an ophthalmologist.

The dangers of ignoring treatment

Refusal of treatment in childhood can lead to the inability to choose many professions in the future, for example: surgeon, artist, professional driver and a number of other specialties associated with intense visual work.

If, however, strabismus was not corrected in childhood, then now it is possible to have surgery to correct strabismus at any age. It is necessary for an ophthalmologist to conduct an examination, after which he will prescribe a surgical operation based on the condition of the oculomotor system and the angle of deviation of the eye.

Currently, it is customary to perform only such operations in which the muscles remain connected to the eyeball, since these operations can be dosed to a certain extent. The correct position of the eyes can be restored in the vast majority of cases.

In order to weaken the muscle, recession (moving away), partial myotomy (incomplete dissection), tenomyoplasty (lengthening), etc. are performed, and to strengthen (shortening) - resection of the muscle-tendon part and prorrhaphy (movement anteriorly).

There are two types of operations to correct strabismus: strengthening and weakening. The principle of weakening surgery is to change the attachment site of the muscle, which the ophthalmic surgeon transplants further from the cornea, after which the action of the strong muscle (the one towards which the eye is deviated) is weakened.

Treatment of this disease should not be delayed, since over time the eye deviated to the side begins to see worse over time. With strabismus, in most cases, only the eye that performs vision retains the ability to see normally.

You need to know that the goal of operations to correct strabismus is to achieve an aesthetic effect; restoring binocular vision (when two images received by the eyes is combined by the brain into one) is very difficult and such treatment must be approached comprehensively and thoroughly.

Sometimes both eyes are operated on at once; in some types of strabismus, only one eye is operated on. The essence of operations to correct strabismus comes down to strengthening or weakening one of the muscles that move the eyeball. This operation is performed on an outpatient basis, under local drip anesthesia. The patient returns home the same day.

Transaction statistics

Surgical intervention in the treatment of concomitant strabismus is used in cases where conservative methods fail to achieve symmetrical eye position. All children with non-accommodative strabismus and 35-40% with partially accommodative strabismus are subject to surgical treatment.

Most ophthalmologists consider the most favorable age for surgery to be 4-6 years (before entering school), when the effect of glasses on the angle of strabismus has already been clearly determined and it is already possible to carry out orthoptic exercises in the pre- and postoperative periods.

The exception is children with congenital and early-onset strabismus with a large angle of deviation - 45° or more. Correcting such a large deviation with a one-time operation is impossible, so surgical treatment is carried out in two and sometimes three stages.

The first stage - reducing the angle of strabismus - should be carried out, if possible, earlier, in the first or second year of life, as soon as the general condition of the child allows the use of anesthesia and the operation.
The second stage - correction of strabismus - can be carried out at 4 - 5 years.

The entire period between the first and second operations, the child should receive the treatment indicated in each specific case: optical and therapeutic correction, direct or alternating occlusion, penalization, training of the extraocular muscles, and, if possible, hardware pleoptic and orthoptic treatment.

The surgical operation often takes place in 2-3 stages, if necessary, pleoptic treatment is carried out, after restoration of the correct position of the eyes - orthoptic-diploptic treatment.

You should not rush into surgery in children with partial accommodative strabismus and a small angle of deviation - up to 10 degrees - and a clear tendency to decrease it.

In these cases, it is necessary to extend active conservative treatment using all indicated and available methods, and the decision on surgical treatment should be postponed to a later date. In some of these children, strabismus treatment was successfully completed without surgery.

The question remains debatable about the need for surgical treatment of children with convergent strabismus in cases where with glasses there is a symmetrical position of the eyes and binocular vision, and without glasses there is a deviation to the nose and binocular vision is impaired.

Many ophthalmologists believe that in such cases it is necessary to surgically weaken the internal rectus muscles (their recession) and achieve the correct position of the eyes without glasses.

The experience of observing such children after operations does not confirm the correctness of this position, since in some children with similar data the appearance of secondary divergent strabismus was noted. After analyzing cases of this unpleasant complication, we identified the reasons for its occurrence.

• The binocular vision that existed before the operation was destroyed during surgery on the extraocular muscles, and after the operation no vigorous measures were taken to restore it, to develop strong fusion reserves that could prevent secondary deviation of the eyeball.
• In some children, there was a change in the configuration of the orbits due to the growth of the bones of the facial skull, which, with instability or absence of binocular vision, led to the appearance of divergent strabismus.
• In some children, the optical plus spherical correction was not weakened in a timely manner, which could have prevented the appearance of outward deviation.

We believe that if a child has established a symmetrical position of the eyes and has developed binocular vision with glasses, then there is a chance of achieving this without glasses. This requires time and persistent treatment.

In such cases, the extraocular muscles are trained on a muscle trainer, we strengthen the external rectus muscles with electrical stimulation, we develop and train negative fusional reserves, we carry out exercises to dissociate between accommodation and convergence, and we strengthen binocular vision with orthopto-diploptic exercises.

And we achieve success! Symmetrical eye position and binocular vision are gradually established without glasses. If for some reason the patient cannot receive such treatment, then he cannot be operated on.

Risk of surgery

Having destroyed his binocular vision through the operation and not being able to restore it, we increase the risk of developing secondary divergent strabismus. Patients with asymmetric binocular vision should not be operated on.

If there is a deviation, when examined on a color test and with the help of striped Bagolini glasses, binocular vision is determined, and on a synoptophore in the zero position of the optical heads, a fusion of objects is determined.

After surgical restoration of the symmetrical position of the eyes, these patients develop persistent diplopia, which disappears only after the eyes return to their previous oblique position (relapse of strabismus).

Children with such an anomaly are subject to long-term vigorous treatment to destroy and weaken the abnormal functional connections formed in the higher parts of the visual analyzer and only after treatment can they be operated on.

Indications for surgery

In the therapeutic treatment of strabismus, different techniques are used:

1. pleoptic course aimed at increasing visual load on the problem eye;
2. orthopedic – provides for the restoration of binocular function of each eye;
3. diplopic method - a set of therapeutic measures aimed at obtaining a complex result provided for by the pleoptic and orthopedic course;
4. active training of the oculomotor muscles.

After therapeutic treatment, the patient is examined again by a specialist. If conservative methods fail to restore eye symmetry, the patient is recommended to undergo surgical treatment of strabismus. The best age for operating on young patients is 4-6 years.

During the rehabilitation period, the person operated on will have to perform certain eye exercises.

The purpose of the operation: to eliminate the asymmetrical arrangement of the visual organs. After surgery, positive visual changes are observed. If the patient also has vision problems, additional intervention will be required, since conventional surgery to correct strabismus does not improve vision.

Surgical treatment of strabismus gives effective results if the patient has a non-accommodative or partially accommodative form of pathology, within 35-40%.

If the deviation angle is 45% or more, one operation to eliminate the visible defect will not be enough. As a rule, in such cases, the surgical procedure is carried out in 2-3 stages, which depends on the severity.

Types of surgery

Due to the fact that surgical treatment of strabismus is a very important stage in getting rid of this disease, it requires a responsible approach and careful preoperative preparation. It includes psychological preparation, a full examination and correction of detected deviations.

Ophthalmological training is of great importance, which will allow one to develop binocular vision instead of occlusion. Sometimes it may be necessary to loosen the nerve connections and train the extraocular muscles.

In addition, a number of procedures may be required that will improve treatment results during the postoperative period. There are two types of operations:

• Weakening.
• Strengthening.

With weakening, there is a change in the place where the muscles are attached. It simply moves deeper from the cornea. This causes the muscle that caused the eye to deviate to weaken.

Strabismus Correction

With an intensifying type of intervention, the muscle is shortened by removing one of its segments. In this case, the location of the muscle attachment remains unchanged. After these manipulations, the eye muscles are balanced by strengthening the weak or weakening the strong muscle.

The exact type of operation to be used is determined by the surgeon directly at the surgical table. This is due to the fact that this choice is influenced by many factors, for example the following:

1. Patient's age;
2. Location of the extraocular muscles;
3. Strabismus angle;
4. Condition of the oculomotor system.

Usually several muscles are operated on at once. If the patient has alternating strabismus (the eyes alternately deviate from the central axis), then surgical intervention is performed simultaneously on the muscles of both eyes. There are cases when a combined intervention is provided (strengthening one muscle and simultaneously weakening another).

Surgery occurs under local anesthesia, and final recovery takes about seven days. Doctors strongly recommend that you also undergo a course of hardware treatment.

Hardware surgery

In general, there are two types of operations for strabismus. The first type of surgery is aimed at weakening the overly tense extraocular muscle. Examples of such operations are recession, partial myotomy, and muscle plastic surgery.

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, tenorrhaphy (shortening of the muscle by forming a fold in the muscle tendon area), anteposition.

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.

• Excessive acceleration of 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).
• If it is necessary to weaken or strengthen individual muscles, dosed surgical intervention should be distributed evenly.
• 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 with the principles of mathematical modeling. Advantages of high-tech eye surgery:

1. The operations are low-traumatic; thanks to the use of radio waves, the structures of the eye are preserved.
2. After the operations there is no terrible swelling, the patient is discharged from the hospital the next day.
3. Operations are precise.
4. 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.
5. 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 is a unique way to effectively help the patient.

Surgical treatment of strabismus in children

Conservative treatment of strabismus involves long-term and active implementation of a set of pleopto-orthoptic exercises. In cases where this does not eliminate strabismus, they proceed to surgical treatment.

Duration of the operational process

Surgery to eliminate strabismus in adult patients can be performed at any time, depending on the patient’s wishes. Before you dare to undergo surgery for strabismus, you need to understand that this surgical intervention will help get rid of the external manifestations of strabismus.

The return of lost vision is not possible in all cases. The choice of surgical intervention is significantly influenced by the angle of deviation of the eye and the general condition of the oculomotor system.

Nowadays, it is customary to perform only those operations in which the muscles are not separated from the eyeballs, because these operations can be dosed to a certain extent. To weaken the muscle, they use recession (moving away), partial myotomy (incomplete dissection), tenomyoplasty (lengthening), etc.

To strengthen it, resection (removal) of the tendon-muscular part and prorrhaphy (movement forward) are performed. The physiological position of the eyes during these operations can be restored in most cases (up to 90%). After surgery, a slight deviation (deviation) may remain.

In the future, this deviation can be eliminated with conservative orthopto-diploptic treatment. Repeated operations are rarely necessary. Surgical treatment of strabismus in children and adults can be carried out in two ways: enhancing and weakening interventions are performed.

With weakening surgical interventions, the attachment site of the extraocular muscle is changed. It is transplanted further from the cornea. In this way, the tension of a strong muscle is weakened (in the direction where the eye is deviated).

Strengthening surgery consists of shortening the muscle by removing (resecting) a certain part of it. The place of attachment to the eyeball does not change. This enhances the action of the weakened opposite muscle.

This surgical intervention makes it possible to restore uniform muscle balance by strengthening or weakening one of the extraocular muscles. The surgeon gives preference to one or another type of surgical intervention directly on the operating table.

This is due to many features that need to be taken into account: the angle of strabismus, the location of the muscles in a particular patient, the state of his oculomotor system, age and other individual characteristics. Often, several muscles of the oculomotor system are operated on.

Simultaneous operations, which are performed on the muscles of the same name in both eyes, are preferred for alternating strabismus. If indicated, combined ophthalmological operations are also performed. During which the extraocular muscle of one eye is simultaneously weakened and the muscle of the other eye is strengthened (resected).

It is important that surgical treatment results in a good cosmetic effect. After all, most patients, both children, adolescents and adults, are constantly in a state of stress because of their appearance. The operation eliminates this problem.

Surgical treatment to correct strabismus is carried out under local (drip) anesthesia. Final recovery after such surgery takes about one week, but ophthalmologists strongly recommend undergoing an additional course of hardware treatment.

Experts have proven that a person with normal vision sees a slightly different image with the right and left eyes. You can check this by closing first one and then the other eye. Normal vision is binocular.

And in order for the operated patient to see one image, and not two, just performing the operation is not enough. This is due to the fact that the brain is not yet accustomed to such work. It is in order to restore physiological binocular vision that constant exercise over a long period of time is required.

The essence of surgical treatment

Strabismus is the result of an imbalance between the 6 extraocular muscles. During strabismus surgery, these muscles are weakened or strengthened in such a way as to restore the lost balance and thus return the eyes to their correct position.

Muscle weakening is done by moving the end of the muscle closer to the equator of the eye, so that its tone decreases. Muscle strengthening is performed by removing part of the muscle and suturing the remainder to the site of fixation, which leads to shortening of the muscle and increasing its tone.

Surgery with customizable sutures is a modern method for correcting strabismus, which significantly increases the success of the operation. The essence of the method is to apply muscle sutures so that they can be adjusted when the patient regains consciousness after surgery.

If, after waking up, the correction is insufficient, open the muscle suture knot and tighten the threads until the desired effect is achieved. It is important to note that the modern technique of general anesthesia is safe and low-risk, and the likelihood of serious complications with it is approximately close to the likelihood of a traffic accident on the way to the hospital.

Using this method gives an additional 10% success rate. Surgeries to correct strabismus in children are performed only under general anesthesia, while in adults the choice of anesthesia depends on the patient and the doctor’s preferences.

Most patients return to school or work within three days after surgery. You should follow your doctor's instructions and use the prescribed eye drops for two weeks after surgery. After about three weeks after the operation, its symptoms disappear.

Modern techniques for surgical correction of strabismus are very effective, although they do not reach one hundred percent. In 10-15% of operations, residual mild strabismus remains, which, according to the majority of operating strabologists, does not interfere with normal life and performance of duties.

If residual strabismus is of a high degree, it is possible to perform a repeat correction operation, since the operation is performed on the extraocular muscles and poses virtually no threat to vision. In very rare cases, infection of the surgical site occurs, which, fortunately, can be effectively treated with drops of antibiotics.

Sometimes double vision appears in the early postoperative period, which goes away within a few days. In especially rare cases, diplopia does not go away and then there is a need for additional types of correction.

Conditions for the operation

Since recovery from strabismus correction surgery is quite quick and easy, many patients from abroad combine a pleasant trip with medical tourism and undergo surgery in the Holy Land. You must arrive two to three days before surgery for a check.

After a couple of weeks after surgery, you can return home. It is important to bring all medical certificates and documents from previous inspections with you to the inspections. Correct eye position can be restored in the vast majority of cases (up to 90%). Repeated operations are rarely required.

Surgical treatment of strabismus consists of either weakening the action of a strong muscle (the one towards which the eye is deviated), or, conversely, strengthening the action of a weak one, that is, the opposite muscle. The volume and nature of the intervention are chosen depending on the condition of the oculomotor system, the angle of strabismus and the age of the patient.

In many cases, it is necessary to resort to combined operations, both on strong and weak muscles, interventions on both eyes, and surgical treatment of strabismus in several stages.
Strabismus surgery can be performed under either general or local anesthesia.

After surgery, it is mandatory to carry out conservative therapy, which is aimed at complete rehabilitation of visual functions, and hardware treatment aimed at restoring and strengthening binocular vision, otherwise strabismus may recur.

Rehabilitation

Surgical treatment of strabismus allows you to correct a cosmetic defect, which is a strong traumatic factor for patients of any age. 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.

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).

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 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. 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

Results of the operation

When deciding to undergo surgery for strabismus, you need to know that such a surgical intervention allows you to get rid of the external manifestations of strabismus, but does not always return the ability to see well.

There are two types of operations for strabismus: strengthening and weakening. During weakening surgery, the attachment site of the muscle is changed and it is transplanted further from the cornea. That is, the action of a strong muscle (the one towards which the eye is deviated) weakens.

During augmentation surgery, the muscle is shortened by removing part of it, but the attachment site of the muscle to the eyeball remains the same. That is, the action of the weak, opposite muscle is enhanced.

As a result, such surgical intervention allows you to restore the correct muscle balance, strengthen or weaken one of the muscles that move the eyeball.

The type of operation is determined by the surgeon directly on the operating table, since with such a surgical intervention it is necessary to take into account many features: the angle of strabismus, the location of the muscles in a particular person, the condition of the oculomotor system, the patient’s age, and others.

Typically, several muscles are operated on. Sometimes both eyes are operated on at once; in some types of strabismus, only one eye is operated on. There are cases when an ophthalmic surgeon performs a combined operation on both eyes, both on strong and weak muscles. This operation is performed in several stages.

It is important that the result of surgical intervention is, first of all, a good cosmetic effect. Most people, both adults and children, teenagers, constantly experience psychological trauma because of their appearance. The operation solves this problem.

Surgical treatment to correct strabismus is performed in a “one-day” mode, under local drip anesthesia. The patient returns home on the same day. The final recovery takes about a week, however, after such a surgical operation, doctors strongly recommend a course of hardware treatment.

Experts quite often mention that in a person with normal vision, each eye receives slightly different images (you can verify this by closing first one eye and then the other). Normal vision should be binocular.

Binocular vision is vision with two eyes with the combination of images received by each eye into a single image in the visual analyzer (cerebral cortex). In order for a person to see one picture, and not two, the operation is not enough. The brain is not used to this kind of work.

One of the main results of surgical intervention is an excellent cosmetic effect. After all, strabismus greatly complicates people's lives, especially for children and adolescents who feel a certain discomfort and are sometimes subject to ridicule from their peers.

After surgery, these problems become irrelevant. The difficulty lies in the fact that with normal vision, each eye receives a slightly different picture, which the brain processes and combines into one.

In a person with strabismus after surgical treatment, the brain is not able to immediately acquire the ability to combine these pictures. Therefore, for the normal functioning of binocular vision, it is necessary to perform exercises for a long time to restore this function.