Scleral Penetrations and Perforations in Strabismus Surgery: Incidence, Risk Factors and Sequelae†
Thammanoon Surachatkumtonekul MD*, Pittaya Phamonvaechavan MD*, Suchada Kumpanardsanyakorn MD*, Noppamas Wongpitoonpiya MD*, Akarin Nimmannit MD**
Affiliation : † Presented at the 31st Annual Meeting of the European Strabismological Association, Mykonos, Greece, May 20-23, 2007 This study was approved by Siriraj Ethic Committee * Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand ** Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
Objective : To evaluate the incidence and identify associated risk factors and sequelae of scleral penetrations
and perforations during strabismus surgery.
Material and Method: Medical records of patients who underwent strabismus surgery at Siriraj Hospital
between June 2001 and May 2006 were reviewed. Strabismus operations were performed by residents in
ophthalmology training, pediatric ophthalmology fellows, or attending physicians. The authors documented
demographic data, surgical techniques, and management of the scleral penetrations and perforations. All
patients with scleral penetrations or perforations were examined intraoperation by indirect ophthalmoscopy
and followed up for at least 6 months to determine late sequelae of this complication.
Results : Of the 1025 patients and 2195 procedures, scleral penetrations (full thickness scleral pass without
retinal break) were recognized in 15 procedures (0.68%). No scleral perforation (full thickness scleral pass
with retinal break) was found. The mean age of these complications during strabismus operations was 14.26
years. Scleral penetrations were more likely to occur with rectus muscle recession than rectus muscle
resection. All sclera penetrations occurred while rectus muscles were recessed and reattached to the new
insertions. All 15 scleral penetrations were performed by residents in training or pediatric ophthalmology
fellows. Re-operation in the same extraocular muscle was not a risk factor for this complication. All patients
with scleral penetrations were managed by dilated pupils and fundus examinations and the authors applied
cryotherapy or indirect ophthalmoscopic laser to the retinal lesions. Retinal detachment, vitreous
hemorrhage, and endophthalmitis were not found in the present study.
Conclusion : The incidence of scleral penetrations in the present study was 0.68%. Risk factors of scleral
penetrations in strabismus surgery are rectus muscle recession and surgeon factors. No serious complications
such as retinal detachment or endophthalmitis were found in this study.
Keywords : Scleral perforation, Scleral penetration, Strabismus surgery, Muscle recession, Muscle resection, Complication
