According to a new study muscle isolation procedures were more closely associated with rare postoperative complications of ptosis and strabismus subsequent to glaucoma surgery. This retrospective clinical analysis was performed to assess the prevalence of ptosis, strabismus, and their co-occurrence in patients who underwent glaucoma surgery and to determine the type of surgery most likely to be associated with such outcomes. The study was published in PloS One by Carlo C. and colleagues.
This study was conducted to find the prevalence of ptosis, strabismus, and their concurrent occurrence following glaucoma surgery and investigate which of the surgical approaches displayed the highest rate of association with these postoperative complications.
In the tertiary university eye clinic of Genoa, a retrospective review was made of 705 patient records who underwent glaucoma surgery from January 1, 2010 to December 31, 2020. The surgical procedures performed were grouped into three categories, namely, “ab interno,” “ab externo,” and “muscle isolation.” The development of ptosis, strabismus, or both during the postoperative period was assessed and matched against the type and number of procedures performed per patient. Complication rates were compared statistically with those found in patients who did not have postoperative sequelae.
Results
Ptosis in isolation occurred in 26 patients, which is 3.7% of the total cohort, of which two were bilateral cases, and a mean of 2.2 ± 1.08 surgical procedures per affected patient.
Ptosis was most common following muscle isolation surgery, with an incidence of 5.7%.
Isolated strabismus was diagnosed in 12 patients; that is, 1.7% of cases, of whom four had unilateral surgery and eight bilateral, with a mean of 3.3 ± 1.78 procedures per patient.
Strabismus was most common after extraocular muscle manipulation procedures, at 7.5%, and this difference was statistically significant (OR: 6.57; 95% CI: 1.71–21.65; p = 0.003).
Seven patients developed both ptosis and strabismus, 1.0% of the series, including one case of bilateral ptosis, with an average of 2.9 ± 1.07 surgeries, which was significantly different when compared to uncomplicated cases (OR: 1.58; 95% CI: 1.01–2.25; p = 0.02).
The overall combined prevalence following muscle isolation procedures was higher, at 1.9%.
These outcomes emphasized the need for heightened caution during manipulations of the extraocular muscles and pointed out the importance of preventive strategies to minimize postoperative functional and cosmetic morbidity.
Reference:
Catti, C., Tessitore, F., Ferrari, D., Milanesi, F., Acerra, S., Peci, L., Rizzi, A., Semeria, S., Schiavetti, I., Cutolo, C. A., Iester, M., & Vagge, A. (2025). Ocular movement abnormalities and ptosis after glaucoma surgery: A retrospective decade long analysis. PloS One, 20(10), e0335074.
https://doi.org/10.1371/journal.pone.0335074
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