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Preoperative Issues in Adult Strabismus

Correspondence: Requests for reprints should be addressed to: Dr. David K. Wallace, UNC Dept of Ophthalmology, 617 Burnett-Womack CB #7040, Chapel Hill, NC 27599-7040. e-mail: dkwallac{at}med.unc.edu

Preoperatively, strabismus surgeons need to obtain informed consent, identify any ocular or systemic risk factors, decide on the preferred method of anesthesia, and determine whether the patient is an appropriate candidate for an adjustable suture technique. Three major categories of complications should be listed on the consent form: Loss of vision, double vison, and need for reoperation. If a patient is at particulary high risk to have one of these complications, then the surgeon should emphasize this point during the preoperative discussion. The incidence of visual loss after strabismus surgery due to anterior segment ischemia, retinal detachment, or endophthalmitis is approximately 1 in 7,400 cases. The preferred method of anesthesia depends on the procedure planned, the age and general health status of the patient, and whether or not an adjustable suture technique is to be utilized. At the conclusion of the preoperative discussion, the patient should be well informed and comfortable with the choice or procedure, have reasonable postoperative expectations in terms of diplopia, and be prepared for any unexpected complications.

Key words: strabismus, surgery, informed consent