Anandhi Ishwarya M, Rajamani Muralidhar, Hemamalini S, Chidambaram P, Michael Sekar, Ramamurthy D
Department of Pediatric Ophthalmology and Strabismus, The Eye Foundation, Coimbatore, Tamil Nadu, India.
Indian J Ophthalmol. 2025 Sep 1;73(9):1330-1337. doi: 10.4103/IJO.IJO_2624_24. Epub 2025 Jul 18.
Adjustable strabismus surgery offers surgeons the flexibility to refine outcomes postoperatively, with single-stage adjustable strabismus surgery (SSASS) allowing immediate adjustments facilitated by intravenous fentanyl and midazolam.
Our study aims to study the efficacy of a specific drug combination for SSASS.
This prospective study enrolled 32 participants aged 14 years and older undergoing horizontal or inferior rectus muscle surgeries under anesthetist supervision. Premedication with ondansetron, glycopyrrolate, dexamethasone, tramadol, and ketorolac was done with sedation maintained using midazolam and fentanyl. Strabismus surgeries were conducted with monitoring of vital signs and hemodynamic parameters. Postoperative assessments were performed for one day and one month.
Mean surgery duration was 1.1 ± 0.3 hours, with favorable mean intraoperative pain scores of 1.34 ± 0.9 and postoperative pain scores of 1.6 ± 0.9. No significant changes in hemodynamic parameters or postoperative vomiting were observed. However, substantial exotropic drift reduced success rates to 87.5% on the first postoperative day and 78.1% at one month.
Our findings demonstrate effective analgesia, hemodynamic stability, and surgeon comfort during SSASS with the studied drug combination. Ketorolac likely contributed to low postoperative pain scores, enabling conservative fentanyl dosing. Despite initial success in alignment, exotropic drift challenges long-term outcomes, suggesting a need for revised target angles in future studies to improve results.
可调节斜视手术为外科医生提供了术后优化手术效果的灵活性，单阶段可调节斜视手术（SSASS）允许在静脉注射芬太尼和咪达唑仑的辅助下进行即时调整。
我们的研究旨在探讨一种特定药物组合用于单阶段可调节斜视手术（SSASS）的疗效。
这项前瞻性研究纳入了32名14岁及以上在麻醉师监督下接受水平或下直肌手术的参与者。术前使用昂丹司琼、格隆溴铵、地塞米松、曲马多和酮咯酸进行预处理，并使用咪达唑仑和芬太尼维持镇静。斜视手术过程中监测生命体征和血流动力学参数。术后进行一天和一个月的评估。
平均手术时间为1.1±0.3小时，术中平均疼痛评分为1.34±0.9，术后疼痛评分为1.6±0.9，效果良好。血流动力学参数和术后呕吐情况均未观察到显著变化。然而，明显的外斜视漂移使术后第一天的成功率降至87.5%，一个月时降至78.1%。
我们的研究结果表明，在所研究的药物组合用于单阶段可调节斜视手术（SSASS）期间，具有有效的镇痛效果、血流动力学稳定性以及外科医生的舒适度。酮咯酸可能有助于降低术后疼痛评分，从而能够保守使用芬太尼剂量。尽管在眼位矫正方面初步取得成功，但外斜视漂移对长期效果构成挑战，这表明在未来的研究中需要调整目标角度以改善结果。
