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DISCUSSION
There is a major role of nonsurgical conservative management for consecutive strabismus which includes alternate occlusion, use of prisms and correction of refractive error. Such methods are quite successful in the subjects with consecutive deviation less than 15PD. There is usually spontaneous regression in comitant consecutive strabismus with small deviations. The patients with the deviation less than 15PD should be observed for few weeks after first surgery. Surgical intervention is considered for those who do not follow conservative treatment, or there is no improvement in the deviation after six months of primary surgical procedure. The deviations of more than 15PD usually require second surgery[11]. In this series two children with consecutive esotropia of less than 15PD were advised for alternate occlusion. Sometimes it becomes hard enough to reoperate on the muscles that were operated during the first surgery to get the eyes visually aligned. Burke[12] suggested the horizontal muscle surgery on opposite eye for the patients underwent monocular muscle recession and resection in first surgery. This study also followed the same technique, the repeat surgery was performed on second dominant eye which was saved during first surgery.In different studies the success rate of secondary surgical procedure for consecutive strabismus was reported as 78%[13] and 88%[14]. According to Park et al[15] the surgical outcome of consecutive squint was 100% successful. In this study, 80.0% (eight subjects) achieved successful surgical outcome at the last followup.
Sometimes there is an increased tendency of developing a consecutive deviation particularly after lateral rectus muscle advancement in consecutive esotropia of larger deviations. Therefore the operating surgeon has to be very careful before planning the amount of muscle adjustment and surgical technique[16]. The increasing rate of consecutive strabismus strongly favors augmented muscle correction at the time of primary surgical intervention particularly in larger deviations of more than 65PD.
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