ผลการผ่าตัดตาเหล่แนวนอนโดยจักษุแพทย์ทั่วไปคนเดียวและปัจจัยทำนายความสำเร็จ: การศึกษาแบบย้อนหลัง

Panwad Uthiyo

doi:10.64960/srimedj.v41i5.271691

Authors

Panwad Uthiyo Department of Ophthalmology, Mukdahan Hospital, Mueang District, Mukdahan Province, Thailand 49000

DOI:

https://doi.org/10.64960/srimedj.v41i5.271691

Keywords:

strabismus surgery, exotropia, surgical outcomes, amblyopia, general ophthalmologist

Abstract

Background and objective: Most published reports on strabismus surgery outcomes originate from specialist centers, including tertiary referral hospitals and academic institutions. In Thailand, however, strabismus surgery may also be performed by general ophthalmologists in general hospitals. Evidence regarding surgical outcomes in this real-world setting remains scarce, especially data stratified by strabismus subtype. This study aimed to evaluate the surgical outcomes of horizontal strabismus and identify factors associated with surgical success in a general ophthalmology setting.

Methods: This retrospective cohort study included 80 consecutive patients who underwent primary horizontal strabismus surgery performed by a single general ophthalmologist (not a strabismus specialist) in Thailand between 2019 and 2025. Surgical success was defined as postoperative alignment within 10 prism diopters (PD) of orthotropia at final follow-up. Outcomes were analyzed by strabismus subtype. Univariable logistic regression was performed, followed by Firth penalized logistic regression to account for complete separation.

Results: The overall short- to intermediate-term surgical success rate was 68.8% (55/80). Success rates differed significantly by subtype (p<0.001): esotropia (ET) 83.3%, exotropia intermittent basic (XT-IB) 83.3%, XT convergence insufficiency 75.0%, XT sensory 44.4%, XT constant 37.5%, and XT divergence excess (XT-DE) 0.0%. On multivariate analysis using Firth penalized logistic regression (n=75), only XT constant and sensory subtypes remained independently associated with lower odds of success compared with ET (adjusted OR 0.17, 95% CI 0.03–0.97, p=0.046). All XT-DE cases (0/5) failed and were excluded due to complete separation.

Conclusions: In strabismus surgery performed by a general ophthalmologist, strabismus subtype—particularly XT constant and sensory—was the primary determinant of surgical outcome after adjustment, whereas deviation magnitude and surgical dose were not independently associated. The uniformly poor outcomes in XT divergence excess highlight the importance of accurate preoperative subtype classification and appropriate referral to strabismus specialists for selected subtypes.

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