Frequency, Patterns, and Associated Factors of Postoperative Complications After Pediatric Strabismus Surgery: A Prospective Observational Study

Abstract

Strabismus surgery is a common intervention in pediatric ophthalmology aimed at restoring ocular alignment and improving binocular vision. While effective, the procedure carries a risk of postoperative complications that may affect long-term outcomes. Objectives: To determine the frequency, pattern, and associated factors of postoperative complications in children undergoing strabismus surgery during follow-up assessments. Methods: This prospective, observational cohort study was conducted from Jan 2023 to May 2025 at the Department of Ophthalmology, Hayatabad Medical Complex (HMC), Peshawar, Pakistan. Institutional ethical approval was obtained before commencement of the study. Written consent from the legal guardian (s) was also obtained for all children included in the study before their inclusion. Results: A total of 34 (28.3%) children developed postoperative complications. Amongst which the most common complications were under correction (5.8%), overcorrection (4.2%), diplopia/loss of binocular fusion (2.5%), postoperative inflammation (2.5%), and granuloma formation (2.5%). 9 children (7.5%) required reoperation because of recurrence or severe residual deviation. Each patient had an average of 2.1 ± 0.6 extraocular muscle procedures. Intraoperative complications were uncommon and occurred in 4 children (3.3%), including scleral thinning without perforation and minor muscle hemorrhage. Conclusions: Postoperative complications were observed in a considerable proportion of children undergoing strabismus surgery in this cohort. There were several clinical and operative variables, such as older age, complex strabismus, surgery, intraoperative complications, and amblyopia, which were linked to higher postoperative risk.