Simultaneous or sequential surgery
A paper published in OPRS journal has attempted to answer a common query when it comes to patients having both ptosis and squint. Generally, it is believde and practiced that squint surgery should be done prior to
ptosis surgery as performing the surgeries the other way around or in a combined procedure may lead to suboptimal results of ptosis correction due to changes in lid position induced by changes in the globes alignment. This is particularly significant when performing squint surgeries for vertical misalignment. This paper compared simultaneous squint and ptosis surgeries with sequential study where the one surgery was followed by the other surgery after a gap of at least 7 weeks (squint surgery first in 6/18 cases. Success of ptosis surgery (margin reflex distance 1 ≥ 2 mm, good eyelid contour, and good eyelid crease) and strabismus surgery (ocular alignment within 10 prism diopters of orthophoria and/or improved head position); were evaluated. In 56 children, 38 simultaneous surgeries versus 18 sequential surgeries, the authors found that there were no significant differences between the groups with regards to surgical success rates, complications, or reoperations (all p > 0.28). They therefore concluded that despite a theoretical risk of postoperative eyelid malposition or complications when surgeries were performed in a combined manner, the rate of such outcomes was not increased with simultaneous surgeries. Performing ptosis and strabismus surgery together appears to be clinically effective and safe, and reduces anesthesia exposure during childhood.
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Revere KE, Binenbaum G, Li J, Mills MD, Katowitz WR, Katowitz JA. Simultaneous Versus Sequential Ptosis and
Strabismus Surgery in Children. Ophthal Plast Reconstr Surg. 2017 Jun 28. Should we attemp
Should we attempt to repair a canalicular injury after 48 hours?
Canalicular injuries are often encountered in facial trauma cases. Generally, the dictum is to operate them early for best results. However in some cases, this may not be possible and such cases are operated late without an attempt to repair the canaliculus. A recnt study challenges this practice and evaluates whether delayed repair of traumatic canalicular laceration affects the final outcome. The medical records of 334 patients who underwent primary traumatic canalicular laceration repair were retrospectively reviewed in the study. Patients were divided into 2 groups according to the surgical timing within 48 hours (early) or after 48 hours (delayed). The anatomic results were compared between these 2 groups. The causes of delayed repair and the mean operation time were also analyzed. Among the 301 cases who had early repair, there were 23 failed attempts vis-à-vis 3 failed cases among 33 patients who had a repair after 48 hours (P = .732). There was no significant difference in the mean operation time between the two groups (62 minutes in the early group v/s 66.3 minutes in the delayed group). The major cause of delayed surgery was traumatic brain injury, followed by facial or orbital fracture, long bone fracture, and chest injury. The study concluded that delayed canalicular repair in unstable patients did not lead to poor results. An elective scheduled surgery, instead of an urgent repair, is feasible for an experienced surgeon.
Read More:
Chu YC, Wu SY, Tsai YJ, Liao YL, Chu HY. Early Versus Late Canalicular Laceration Repair Outcomes. Am J Ophthalmol. 2017 Aug 24.