{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T21:27:19Z","timestamp":1782422839839,"version":"3.54.5"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background\/Aims<\/jats:title>\n                    <jats:p>To evaluate the prevalence of ptosis, strabismus and the combination of both after glaucoma surgery and determine which kind of surgery is most likely to be linked to these complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 705 clinical records of patients who underwent glaucoma surgery at the University Eye Clinic of IRCCS Ospedale Policlinico San Martino, Genoa, from January 1, 2010, to December 31, 2020, were retrospectively evaluated. Surgery procedures were divided in three groups: \u201cAb interno\u201d, \u201cAb externo\u201d and \u201cMuscle isolation\u201d.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of all patients 26 developed ptosis alone (3.7%), two developed bilateral ptosis, with a mean of 2.2\u2009\u00b1\u20091.08 procedures per patient. Highest incidence of ptosis was noticed in patients who underwent muscle isolation surgery (5.7%). Twelve patients developed strabismus alone (1,7%), four underwent unilateral surgery and eight bilateral surgery, with an average of 3.3\u2009\u00b1\u20091.78 procedures per patient. Strabismus was more frequent following extraocular muscle manipulation surgery (7.5%), showing a statistically significant difference (OR: 6.57; 95% CI: 1.71\u201321.65; p\u2009=\u20090.003) Seven patients developed both strabismus and ptosis (1.0%), one patient with bilateral ptosis. Four underwent bilateral surgery and three underwent unilateral surgery. The mean number of surgeries was 2.9\u2009\u00b1\u20091.07, showing a statistically significant difference compared to the uncomplicated glaucoma group (OR: 1.58; 95% CI: 1.01\u20132.25; p\u2009=\u20090.02). The prevalence of both ptosis and strabismus was higher after muscle isolation surgery (1.9%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Ptosis, strabismus and the combination of both are rare complications after glaucoma surgery, mostly linked to surgery with muscle isolation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0335074","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:30:56Z","timestamp":1761845456000},"page":"e0335074","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Ocular movement abnormalities and ptosis after glaucoma surgery: A retrospective decade long analysis"],"prefix":"10.1371","volume":"20","author":[{"given":"Carlo","family":"Catti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Tessitore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Ferrari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Milanesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Acerra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Peci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Rizzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio","family":"Semeria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Schiavetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo Alberto","family":"Cutolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Iester","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9346-9267","authenticated-orcid":true,"given":"Aldo","family":"Vagge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"pone.0335074.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bjophthalmol-2021-egsguidelines","article-title":"Terminology and Guidelines for Glaucoma, 5th Edition","volume":"105","author":"European Glaucoma Society","year":"2021","journal-title":"Br J Ophthalmol"},{"key":"pone.0335074.ref002","article-title":"Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis","author":"YC Tham","year":"2020","journal-title":"Ophthalmology"},{"issue":"4","key":"pone.0335074.ref003","first-page":"673","article-title":"Trabeculectomy. Preliminary report of a new method","volume":"66","author":"JE Cairns","year":"1968","journal-title":"Am J Ophthalmol"},{"issue":"1","key":"pone.0335074.ref004","doi-asserted-by":"crossref","DOI":"10.1097\/OPX.0b013e3181fe2226","article-title":"A history of the surgical management of glaucoma","volume":"88","author":"MR Razeghinejad","year":"2011","journal-title":"Optom Vis Sci"},{"key":"pone.0335074.ref005","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1159\/000458485","article-title":"Glaucoma Drainage Implant Surgery","volume":"59","author":"AA Aref","year":"2017","journal-title":"Dev Ophthalmol"},{"issue":"7","key":"pone.0335074.ref006","article-title":"A Comprehensive Review of Recent Advances in Minimally Invasive Glaucoma Surgery: Current Trends and Future Directions","volume":"16","author":"KK Dhawale","year":"2024","journal-title":"Cureus"},{"issue":"1","key":"pone.0335074.ref007","doi-asserted-by":"crossref","first-page":"19","DOI":"10.4274\/tjo.galenos.2020.12269","article-title":"Evaluation of Diplopia Secondary to Seton Implantation Surgery: Ahmed Glaucoma Valve and Diplopia","volume":"51","author":"S Ta\u015fkoparan","year":"2021","journal-title":"Turk J Ophthalmol"},{"key":"pone.0335074.ref008","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s40942-018-0135-x","article-title":"Retina and glaucoma: surgical complications","volume":"4","author":"NK Sahoo","year":"2018","journal-title":"Int J Retina Vitreous"},{"issue":"4","key":"pone.0335074.ref009","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1001\/archopht.126.4.480","article-title":"Surgical treatment of strabismus secondary to glaucoma drainage device","volume":"126","author":"A Roizen","year":"2008","journal-title":"Arch Ophthalmol"},{"issue":"6","key":"pone.0335074.ref010","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/IJG.0000000000000174","article-title":"Incidence of Postoperative Ptosis Following Trabeculectomy With Mitomycin C","volume":"24","author":"A Naruo-Tsuchisaka","year":"2015","journal-title":"J Glaucoma"},{"key":"pone.0335074.ref011","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3368\/aoj.62.1.9","article-title":"Diplopia after glaucoma surgery","volume":"62","author":"SP Christiansen","year":"2012","journal-title":"Am Orthopt J"},{"key":"pone.0335074.ref012","article-title":"Section 6: Pediatric Ophthalmology and Strabismus","volume-title":"Basic and Clinical Science Course","author":"American Academy of Ophthalmology","year":"2021"},{"key":"pone.0335074.ref013","first-page":"1","article-title":"Ptosis surgery.","volume-title":"Duane\u2019s Clinical Ophthalmology","author":"JW Iliff","year":"2001"},{"issue":"2","key":"pone.0335074.ref014","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.ophtha.2016.10.006","article-title":"Diplopia in Medically and Surgically Treated Patients with Glaucoma","volume":"124","author":"PY Sun","year":"2017","journal-title":"Ophthalmology"},{"issue":"2","key":"pone.0335074.ref015","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.jaapos.2012.11.017","article-title":"Diplopia after glaucoma drainage device implantation","volume":"17","author":"A Abdelaziz","year":"2013","journal-title":"J AAPOS"},{"key":"pone.0335074.ref016","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajo.2020.08.019","article-title":"Strabismus After Ahmed Glaucoma Valve Implantation","volume":"222","author":"L Robbins","year":"2021","journal-title":"Am J Ophthalmol"},{"issue":"5","key":"pone.0335074.ref017","doi-asserted-by":"crossref","first-page":"396","DOI":"10.3928\/1542-8877-19990501-12","article-title":"Acquired Pseudo-Brown\u2019s syndrome immediately following Ahmed valve glaucoma implant","volume":"30","author":"DK Coats","year":"1999","journal-title":"Ophthalmic Surg Lasers"},{"issue":"1","key":"pone.0335074.ref018","doi-asserted-by":"crossref","first-page":"44","DOI":"10.3928\/0191-3913-19920101-09","article-title":"Motility disturbances after Molteno implants","volume":"29","author":"LM Christmann","year":"1992","journal-title":"J Pediatr Ophthalmol Strabismus"},{"issue":"2","key":"pone.0335074.ref019","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1080\/2576117X.2020.1734431","article-title":"Otago Glaucoma Surgery Outcome Study: Examining the Development of Strabismus Causing Diplopia in Patients Who Have Received Molteno Implant Surgery","volume":"70","author":"T Borowsky","year":"2020","journal-title":"J Binocul Vis Ocul Motil"},{"issue":"5","key":"pone.0335074.ref020","doi-asserted-by":"crossref","first-page":"272","DOI":"10.3928\/01913913-20170703-01","article-title":"Strabismus After Ocular Surgery","volume":"54","author":"EK Sobol","year":"2017","journal-title":"J Pediatr Ophthalmol Strabismus"},{"issue":"10","key":"pone.0335074.ref021","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0276527","article-title":"Magnetic resonance imaging reveals possible cause of diplopia after Baerveldt glaucoma implantation","volume":"17","author":"E Islamaj","year":"2022","journal-title":"PLoS One"},{"issue":"3","key":"pone.0335074.ref022","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.ajo.2008.09.019","article-title":"Motility disturbances in the tube versus trabeculectomy study during the first year of follow-up","volume":"147","author":"FM Rauscher","year":"2009","journal-title":"Am J Ophthalmol"},{"issue":"7","key":"pone.0335074.ref023","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1007\/s00417-020-04630-x","article-title":"Increased rate of ptosis following glaucoma drainage device placement and other anterior segment surgery: a prospective analysis","volume":"258","author":"GW Roddy","year":"2020","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"pone.0335074.ref024","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.2147\/OPTH.S134562","article-title":"Ptosis after glaucoma surgery","volume":"11","author":"AJ Park","year":"2017","journal-title":"Clin Ophthalmol"},{"issue":"6","key":"pone.0335074.ref025","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.survophthal.2016.03.008","article-title":"Oculoplastic considerations in patients with glaucoma","volume":"61","author":"P Tan","year":"2016","journal-title":"Surv Ophthalmol"},{"issue":"4","key":"pone.0335074.ref026","doi-asserted-by":"crossref","first-page":"274","DOI":"10.3109\/01676830.2012.681750","article-title":"Blepharoptosis following anterior segment surgery: a new theory for an old problem","volume":"31","author":"MS Mehat","year":"2012","journal-title":"Orbit"},{"issue":"2","key":"pone.0335074.ref027","doi-asserted-by":"crossref","first-page":"85","DOI":"10.4274\/tjo.galenos.2022.58812","article-title":"Factors Affecting the Incidence of Ptosis after Trabeculectomy","volume":"53","author":"E Malko\u00e7 \u015een","year":"2023","journal-title":"Turk J Ophthalmol"},{"issue":"5","key":"pone.0335074.ref028","doi-asserted-by":"crossref","first-page":"2886","DOI":"10.1177\/11206721211063723","article-title":"Changes in eyelid position after glaucoma filtering surgery","volume":"32","author":"T Salv\u00e1-Palomeque","year":"2022","journal-title":"Eur J Ophthalmol"},{"issue":"11","key":"pone.0335074.ref029","doi-asserted-by":"crossref","first-page":"3687","DOI":"10.1007\/s10792-021-01928-5","article-title":"Impact of age, sex and refractive error on conjunctival and Tenon\u2019s capsule thickness dimensions by swept-source optical coherence tomography in a large population","volume":"41","author":"JI Fern\u00e1ndez-Vigo","year":"2021","journal-title":"Int Ophthalmol"},{"issue":"9","key":"pone.0335074.ref030","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1097\/IJG.0000000000000514","article-title":"Supra-Tenon Capsule Implantation of the Ahmed Glaucoma Valve in Refractory Pediatric Glaucoma","volume":"25","author":"EM Elhefney","year":"2016","journal-title":"J Glaucoma"},{"issue":"3","key":"pone.0335074.ref031","doi-asserted-by":"crossref","DOI":"10.1016\/j.jaapos.2019.02.005","article-title":"Risk factors for strabismus following glaucoma drainage device implantation for refractory childhood glaucoma","volume":"23","author":"SD Talsania","year":"2019","journal-title":"J AAPOS"},{"issue":"2","key":"pone.0335074.ref032","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3109\/09273972.2016.1159234","article-title":"Variability of Fusion Vergence Measurements in Heterophoria","volume":"24","author":"C Costa Lan\u00e7a","year":"2016","journal-title":"Strabismus"},{"issue":"4","key":"pone.0335074.ref033","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jaapos.2017.06.009","article-title":"Strabismus and binocular diplopia due to advanced glaucomatous visual field loss","volume":"21","author":"CL Khanna","year":"2017","journal-title":"J AAPOS"},{"issue":"5","key":"pone.0335074.ref034","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1167\/tvst.7.5.7","article-title":"Motility Changes and Diplopia After Baerveldt Glaucoma Drainage Device Implantation or After Trabeculectomy","volume":"7","author":"E Islamaj","year":"2018","journal-title":"Transl Vis Sci Technol"},{"issue":"3","key":"pone.0335074.ref035","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.tjo.2016.05.001","article-title":"Restrictive problems related to strabismus surgery","volume":"6","author":"SB \u00d6zkan","year":"2016","journal-title":"Taiwan J Ophthalmol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335074","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:31:02Z","timestamp":1761845462000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335074"}},"subtitle":[],"editor":[{"given":"Nader Hussien Lotfy","family":"Bayoumi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,30]]},"references-count":35,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0335074","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,30]]}}}