{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:31:23Z","timestamp":1790875883669,"version":"4.1.0"},"reference-count":35,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,2,8]],"date-time":"2025-02-08T00:00:00Z","timestamp":1738972800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The aim of this paper was to evaluate the safety of surgical intervention using anesthesia and ophthalmological parameters in pediatric strabismus patients. The design involved retrospective case series. Methods: The setting was the Department of Ophthalmology, Medical University Vienna, Austria. Participants: In total, 208 children aged 0\u201318 years who underwent strabismus surgery due to exotropia or esotropia between 2013 and 2020 were included. Main outcomes and measures: Information regarding the duration of surgery, intra- and postoperative complications, the postoperative angle of deviation (AoD), and functional outcomes (visual acuity, stereovision) were analyzed. Results: The mean age at the time of surgery was 6.0 \u00b1 4.1 years (range 0.6\u201318.0). The mean anesthesia time among all patients was 75.9 \u00b1 19.3 min. The mean surgery and anesthesia time did not differ between the age groups. Longer anesthesia durations and surgery durations did not have a significant effect on the occurrence of intraoperation complications (p = 0.610 and p = 0.190, respectively). Intraoperative complications were recorded in 53% (most frequent triggering of oculocardiac reflex (OCR)) of the patients, and postoperative complications in 22% (the most frequent were postoperative nausea and vomiting and pain). An OCR was triggered more often in children older than 6 years than in younger children (p = 0.016). The mean angle of deviation was significantly reduced from preoperative to postoperative measurements. Preoperative stereovision tests were positive in 35% of the patients and increased to over 80% postoperatively. Conclusions: Strabismus surgery performed under general anesthesia in children aged 0 to 18 years is safe with regard to both surgical and anesthetic complications. A significant decrease in the angle of deviation and high rate of stereovision could be achieved with a low rate of re-treatments. However, the retrospective design, absence of standardized documentation, and limited sample size may affect the consistency and comparability of this study\u2019s findings.<\/jats:p>","DOI":"10.3390\/jcm14041076","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T03:39:47Z","timestamp":1739158787000},"page":"1076","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Pediatric and Juvenile Strabismus Surgery Under General Anesthesia: Functional Outcomes and Safety"],"prefix":"10.3390","volume":"14","author":[{"given":"Jakob","family":"Briem","sequence":"first","affiliation":[{"name":"Department of Ophthalmology and Optometry, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Rezar-Dreindl","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Optometry, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenz","family":"Wassermann","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Optometry, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Eibenberger","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Optometry, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz","family":"Pusch","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"Schmidt-Erfurth","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Optometry, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Stifter","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Optometry, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1007\/s12630-010-9300-x","article-title":"Anesthetic management for pediatric strabismus surgery: Continuing professional development","volume":"57","author":"Rodgers","year":"2010","journal-title":"Can. J. Anaesth."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1136\/bjo.58.3.224","article-title":"Epidemiology of strabismus","volume":"58","author":"Graham","year":"1974","journal-title":"Br. J. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1001\/jamaophthalmol.2017.3158","article-title":"Strabismus Incidence in a Danish Population-Based Cohort of Children","volume":"135","author":"Boyd","year":"2017","journal-title":"JAMA Ophthalmol."},{"key":"ref_4","first-page":"166","article-title":"Screening-Untersuchung auf Amblyopie, Strabismus und Refraktionsanomalie bei 1030 Kindergartenkindern [Screening for amblyopia, strabismus and refractive abnormalities in 1030 kindergarten children]","volume":"213","author":"Heine","year":"1998","journal-title":"Klin. Monbl. Augenheilkd."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1167\/iovs.03-0945","article-title":"Binocular visual field changes after surgery in esotropic amblyopia","volume":"45","author":"Quah","year":"2004","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.jaapos.2004.12.006","article-title":"Social and emotional impact of strabismus surgery on quality of life in children","volume":"9","author":"Archer","year":"2005","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_7","first-page":"CD004240","article-title":"Adjustable versus non-adjustable sutures for strabismus","volume":"3","author":"Hassan","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1056\/NEJMcp051888","article-title":"Clinical practice. Pediatric strabismus","volume":"356","author":"Donahue","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/S1091-8531(98)90074-X","article-title":"The anesthetic management of the pediatric strabismus patient","volume":"2","author":"Williams","year":"1998","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1097\/ACO.0000000000000073","article-title":"Postoperative nausea and vomiting in pediatric anesthesia","volume":"27","year":"2014","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.jaapos.2004.03.003","article-title":"Scleral penetrations and perforations in strabismus surgery and associated risk factors","volume":"8","author":"Dang","year":"2004","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"140.e1","DOI":"10.1016\/j.jaapos.2018.08.015","article-title":"The incidence and clinical outcome of complications in 4,000 consecutive strabismus operations","volume":"23","author":"Ritchie","year":"2019","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.jaapos.2003.10.003","article-title":"Stereopsis and long-term stability of alignment in esotropia","volume":"8","author":"Birch","year":"2004","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jaapos.2012.10.016","article-title":"Severe complications of strabismus surgery","volume":"17","author":"Bradbury","year":"2013","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"271","DOI":"10.4103\/0974-9233.159692","article-title":"Complications of Strabismus Surgery","volume":"22","author":"Olitsky","year":"2015","journal-title":"Middle East. Afr. J. Ophthalmol."},{"key":"ref_16","first-page":"623","article-title":"The association between surgical technique and oculocardiac reflex in pediatric strabismus surgery: An observational study","volume":"71","year":"2021","journal-title":"Braz. J. Anesthesiol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ha, S.G., Huh, J., Lee, B.R., and Kim, S.-H. (2018). Surgical factors affecting oculocardiac reflex during strabismus surgery. BMC Ophthalmol., 18.","DOI":"10.1186\/s12886-018-0771-9"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2693","DOI":"10.2147\/OPTH.S317447","article-title":"The Oculocardiac Reflex: A Review","volume":"15","author":"Arnold","year":"2021","journal-title":"Clin. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"300060520945158","DOI":"10.1177\/0300060520945158","article-title":"Oculocardiac reflex and oculorespiratory reflex during strabismus surgery under general anesthesia using the laryngeal mask airway with maintenance of spontaneous respiration: A retrospective study","volume":"48","author":"Shin","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1177\/1120672118804798","article-title":"Prospective evaluation of anesthetic protocols during pediatric ophthalmic surgery","volume":"29","author":"Ducloyer","year":"2019","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"4253","DOI":"10.2147\/OPTH.S288578","article-title":"The Impact of Re-Operation, Relatives and Race on the Oculocardiac Reflex During Strabismus Surgery","volume":"14","author":"Arnold","year":"2020","journal-title":"Clin. Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1177\/0310057X20937710","article-title":"Anaesthetic considerations for strabismus surgery in children and adults","volume":"48","author":"Chua","year":"2020","journal-title":"Anaesth. Intensive Care"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Li, S., Liu, T., Xia, J., and Li, W. (2020). Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: A randomized controlled study. BMC Ophthalmol., 20.","DOI":"10.1186\/s12886-020-01359-3"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1111\/j.1365-2044.2007.05220.x","article-title":"A prospective randomised double blind study to evaluate the effect of peribulbar block or topical application of local anaesthesia combined with general anaesthesia on intra-operative and postoperative complications during paediatric strabismus surgery","volume":"62","author":"Gupta","year":"2007","journal-title":"Anesthesia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.jclinane.2016.03.049","article-title":"Comparison of dexamethasone or intravenous fluids or combination of both on postoperative nausea, vomiting and pain in pediatric strabismus surgery","volume":"34","author":"Sayed","year":"2016","journal-title":"J. Clin. Anesth."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s40272-020-00424-0","article-title":"Postoperative Nausea and Vomiting in Pediatric Patients","volume":"23","author":"Kovac","year":"2021","journal-title":"Paediatr. Drugs"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1213\/ANE.0000000000000002","article-title":"Consensus guidelines for the management of postoperative nausea and vomiting","volume":"118","author":"Gan","year":"2014","journal-title":"Anesth. Analg."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Association of Paediatric Anaesthetists of Great Britain and Ireland (2012). Good practice in postoperative and procedural pain management, 2nd edition. Paediatr. Anaesth., 22, 1\u201379.","DOI":"10.1111\/j.1460-9592.2012.03838.x"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1001\/jamaophthalmol.2013.704","article-title":"Three horizontal muscle surgery for large-angle infantile or presumed infantile esotropia: Long-term motor outcomes","volume":"131","author":"Chatzistefanou","year":"2013","journal-title":"JAMA Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"351","DOI":"10.3928\/01913913-20041101-02","article-title":"Long-term results of bilateral medial rectus recession for congenital esotropia","volume":"41","author":"Keskinbora","year":"2004","journal-title":"J. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Pediatric Eye Disease Investigator Group, Writing Committee, Donahue, S.P., Chandler, D.L., Holmes, J.M., Arthur, B.W., Paysse, E.A., Wallace, D.K., Petersen, D.B., and Melia, B.M. (2019). A Randomized Trial Comparing Bilateral Lateral Rectus Recession versus Unilateral Recess and Resect for Basic-Type Intermittent Exotropia. Ophthalmology, 126, 305\u2013317. Correction in Ophthalmology 2020, 127, 1590.","DOI":"10.1016\/j.ophtha.2018.08.034"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jaapos.2008.06.013","article-title":"Long-term follow-up of congenital esotropia in a population-based cohort","volume":"13","author":"Louwagie","year":"2009","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.ajo.2019.12.008","article-title":"The Relationship of Age and Other Baseline Factors to Outcome of Initial Surgery for Intermittent Exotropia","volume":"212","author":"Repka","year":"2020","journal-title":"Am. J. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.ajo.2015.10.022","article-title":"Rates of Reoperation and Abnormal Binocularity Following Strabismus Surgery in Children","volume":"162","author":"Leffler","year":"2016","journal-title":"Am. J. Ophthalmol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1080\/08820538.2019.1687739","article-title":"Long term motor and sensory outcome after surgery for infantile esotropia and risk factors for residual and consecutive deviations","volume":"35","author":"Ziylan","year":"2020","journal-title":"Semin. Ophthalmol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1076\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:29:09Z","timestamp":1760027349000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1076"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,8]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14041076"],"URL":"https:\/\/doi.org\/10.3390\/jcm14041076","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,8]]}}}