Outcomes for combined pediatric cataract and strabismus surgery Alden P. Gregston, MD, Serena X. Wang, MD Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX Children’s Medical Center, Dallas, TX

Purpose Results In the pediatric patient population, both cataracts and Tables 1 and 2 display the results of combined cataract and strabismus strabismus have amblyogenic potential and often occur surgery from 72 patients on 80 eyes. 91.25% of procedures resulted in concurrently. This study seeks to provide the largest improved alignment. 79.5% of patients with quantifiable vision noted retrospective chart review revealing the benefits and pitfalls improvement post-operatively with 35% of all eyes included achieving of addressing both within a single surgery. An evidence-based a visual acuity better than or equal to 20/80. One patient experienced paradigm shift towards combined procedures could decrease IOP elevation to 44 mmHg POD1. The combined nature of procedures costs and anxiety (patient and parent) associated with did not directly contribute to this event. Three patients had strabismus surgery and potentially result in better outcomes than surgery on one eye and cataract/intraocular lens surgery on the fellow consecutive trips to the operating room. eye. This does theoretically increase risks of infection simply by involving both eyes, but there were no complications uncovered in Methods these three cases. Retrospective chart review on patients who underwent cataract removal or secondary intraocular lens placement from January 2010 to December 2020 at Children’sSample Medical Photo Center in Dallas, Texas was performed. Patients without Conclusions concurrent strabismus surgery at the time of cataract Combining procedures aimed at improving vision in children is a safe extraction or IOL implantation were excluded from the study. and effective concept. However, limitations do exist. Surgeons must 76 patients ranging in age from 0 to 17 years old (mean age be capable of performing the procedures in a facility equipped for 5.44) were included for review. 4 of these patients were both. Surgeons must also either be technically skilled in intraocular excluded due to inadequate pre or postoperative data or and strabismus procedures or coordinate with colleagues and being lost to follow-up immediately following the procedure. scheduling can be difficult especially during the COVID-19 era. The Preoperative alignment was measured in all patients using literature does purport that perhaps there is a change in refractive standard tests and quantified in prism diopters. The error following strabismus surgery. However, given our patient strabismus portion of the surgery preceded the intraocular population and likely need for additional ocular surgeries (IOL procedure in all cases. Preoperative and postoperative best exchange) regardless of initial refractive success, this is likely corrected visual acuity was recorded. Postoperative inconsequential. Another consideration is that patients may alignment and visual acuity were noted at months 3-6, year 1- References experience a greater amount of discomfort with a combined surgery. 1. American Association for Pediatric Ophthalmology and Strabismus. 2006/10/01/ 2006;10(5):430-434. doi:https://doi.org/10.1016/j.jaapos.2006.06.007 2, and latest visit whenever possible. Given heterogeneous 2. Squirrell D, Edwards M Fau - Burke J, Burke J. Combined strabismus and phacoemulsification cataract surgery: a useful option in selected patients. (0950-222X (Print)) We did not specifically qualify this in our study, but future 3. Guha S, Ravishankar K, Surendran TS. Performing Combined Strabismus and Cataract Surgery: An Effective Approach in Selected Cases. Strabismus. 2008;16(1):5-9. follow-up periods (1 month to >8 years), data points most doi:10.1080/09273970701821022 investigation would be beneficial. In our study, the risks appear like 4. Zwaan J, al-Sadhan Y. Combined intraocular and strabismus surgery. (1082-3069 (Print)) consistent with the overall clinical picture were evaluated for 5. Gupta PC, Sukhija J, Khurana S, et al. Pediatric cataract surgery practices in the COVID-19 era: Perspectives of a tertiary care institute in Northern India. Indian J Ophthalmol. May those encountered with independent strabismus and pediatric each patient. 2021;69(5):1284-1287. doi:10.4103/ijo.IJO_3678_20 cataract cases. 6. Hutcheson KA. Large, visually significant, and transient change in refractive error after uncomplicated strabismus surgery. (1091-8531 (Print))(Print))