title: Rates of Reoperation and Abnormal Binocularity Following Strabismus Surgery in Children.
abstract: OBJECTIVE
  To determine predictors of reoperation and abnormal binocularity outcomes (including amblyopia and diplopia) following pediatric strabismus surgery.
  
  
  METHODS
  Retrospective cross-sectional study.
  
  
  METHODS
  setting: Review of a national insurance database.
  
  
  METHODS
  Children under age 18 years having strabismus procedures between 2007 and 2013.
  
  
  METHODS
  Adjustable- or fixed-suture strabismus surgery, or botulinum toxin injection.
  
  
  METHODS
  Reoperation or diagnosis of abnormal binocularity in the first postoperative year.
  
  
  RESULTS
  Of 11 115 children having strabismus procedures, 851 (7.7%) underwent reoperation. The reoperation rate was 7.4% for fixed-suture surgeries, 9.6% for adjustable-suture surgeries (P = .18), and 44.9% for botulinum injections (P < .001). Age under 2 years was associated with higher reoperation and abnormal binocularity rates (P < .001). For horizontal strabismus, the postoperative abnormal binocularity rate was 12.8% for fixed-suture surgery and 26.5% for botulinum injection (P = .005). Reoperation rates tended to be higher with adjustable sutures (odds ratio [OR] 1.69, 95% confidence interval [CI] 0.94-3.03, P = .08) or botulinum toxin injection (OR 10.36, 95% CI 5.75-18.66, P < .001) and lower with 3- or 4-muscle surgery (P = .001). Esotropia, hyperopia, and botulinum injection were independently associated with higher rates of postoperative abnormal binocularity (P ≤ .005). For vertical surgeries, predictors of reoperation were adjustable-suture use (OR 2.51, P = .10) and superior oblique surgery (OR 2.36, P < .001).
  
  
  CONCLUSIONS
  Adjustable sutures were not associated with a lower reoperation rate in children. Younger age, esotropia, hyperopia, and botulinum injection were associated with postoperative abnormal binocularity. Superior oblique surgery and botulinum injection were associated with higher rates of reoperation.
authors.affiliation: Department of Ophthalmology, Virginia Commonwealth University Medical Center, Richmond, Virginia. Electronic address: chrislefflermd@gmail.com.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Leffler
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Vaziri
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Schwartz
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Kara M
authors.initials: KM
authors.lastname: Cavuoto
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Craig A
authors.initials: CA
authors.lastname: McKeown
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Krishna S
authors.initials: KS
authors.lastname: Kishor
authors.affiliation: Department of Ophthalmology, Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Janot
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000550:Amblyopia / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004172:Diplopia / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007223:Infant; D009801:Oculomotor Muscles / Q000601:surgery*; D016017:Odds Ratio; D013508:Ophthalmologic Surgical Procedures / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013285:Strabismus / Q000601:surgery*; D013536:Suture Techniques; D014786:Vision Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D015348:Vision, Binocular
chemical_list: D019274:Botulinum Toxins, Type A