Achieving postoperative target range increases success of strabismus surgery in adults: a case for adjustable sutures?
Bibliographic record
Abstract
BACKGROUND/AIMS: To evaluate the role of achieving immediate target angles on the success of strabismus surgery. METHODS: We performed a retrospective cohort study of all patients over 12 years old undergoing strabismus surgery with either adjustable or non-adjustable sutures. Target angle for patients with esotropia and vertical deviation was within 4 prism dioptres (PD) of orthotropia and for patients with exotropia between orthotropia and 8 PD of esotropia. Success was defined as alignment within 10 PD for horizontal rectus surgery and within 5 PD of orthotropia for vertical rectus surgery, without diplopia or reoperations. The main outcome measure was surgical success rate. RESULTS: Three hundred and fifty-three patients were included in the study with mean follow-up of 13.9 (4-132) months. Patients achieving the target angle immediately postoperatively had higher success rate than patients who did not (83.6% vs 63.7%, p<0.0001, OR 2.9, 95% CI 1.8 to 4.9). When target angle was achieved, adjustable and non-adjustable sutures had similar success (84.8% and 80.9%, respectively, p=0.46, OR 1.3, CI 0.58 to 2.9). However, patients undergoing adjustable surgery were more likely to obtain the target angle (75.5% vs 54%, p<0.0001, OR 2.7, CI 1.7 to 4.2). Success for exotropia surgery was significantly higher when the immediate target angle was achieved (86.4% vs 58.7%, p<0.0001, OR 4.47, CI 2.3 to 8.6). For esotropia and vertical deviations, a similar beneficial effect was not shown (p=0.31, OR 1.6, CI 0.65 to 4.0 and p=0.33, respectively). On multiple logistic regressions, sex, amblyopia, binocularity and reoperations were not significant factors in surgical success. CONCLUSIONS: Our results suggest that achieving the immediate target angle is the most significant factor in the success of strabismus surgery for exotropia. Adjustable suture surgery results in higher proportion of patients achieving this target angle.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".