Tabela de planejamento cirúrgico para correção unilateral de estrabismo em serviço universitário de referência em oftalmologia na Bahia

Abstract

Introduction: Strabismus is an ocular motility disorder affecting 2% to 5% of the global population, characterized by a loss of ocular alignment. Its functional and psychosocial impact underscores the need for individualized treatment. Among the therapeutic options, unilateral horizontal rectus muscle surgery is indicated for moderate deviations. However, the absence of surgical dosage tables based on local case series, particularly within Brazilian public services, hinders teaching and the standardization of management protocols. This study aimed to evaluate the efficacy of this approach and to develop a surgical planning table based on institutional data. Objectives: The primary objective was to evaluate the outcomes of unilateral horizontal rectus muscle surgery for strabismus correction in patients treated at the Professor Edgard Santos University Hospital (HUPES-UFBA) and to propose a surgical planning table based on the local case series. Methodology: This was a cross-sectional, retrospective, and observational study. Medical records of 55 patients who underwent unilateral horizontal rectus muscle surgery at HUPES-UFBA between January 2017 and December 2022 were analyzed. Surgical success was defined as a residual deviation of ≤ 10 prism diopters (PD). Results: Unilateral surgery demonstrated high efficacy, with an overall success rate of 85.9% (n=48). Orthotropia (complete alignment) was achieved in 67.9% (n=38) of patients. Amblyopia was present in 62.5% (n=35) of the patients and was associated with lower success rates, accounting for six of the eight cases with residual misalignment greater than 10 PD. The distribution of deviation types was nearly equivalent: 51.8% exotropia and 48.2% esotropia. The analysis of effective surgical dosages allowed for the development of a proposed surgical planning table, specifying recession and resection amounts in millimeters for esotropia and exotropia across different PD ranges. Conclusion: This study reinforces the efficacy of the unilateral approach for correcting horizontal strabismus within a university service setting. The presence of amblyopia was identified as a factor associated with lower success rates. The primary contribution of this work is the proposal of a surgical planning table derived from local data, which may serve as a tool for standardization, medical education, and clinical decision support.