eyes do not align after strabismus operation

[parkap]

HI My son’s case is rather a complicated one so pls bear with me as I fill you with all the details.
I am confused and scared and need some direction.

My son was born 45 days premature and had ROP performed in Singapore on both eyes at one and half months of age.
The doctor told me there was considerable scarring on the retina. My son started wearing specs at 3 yrs of age and as his left eye number went up every year. His left eye began deviating to the outside of the eye and at the age of 8 we had to get a squint surgery done after which we still felt there was a misalignment of both eyes.
At the age of 19yrs (2007)
the left eye had minus 7 eyesight and right eye minus 3.75.
The left eye wandered up and out and when asked to blink it would return to normal. Sometime while talking to people it drifts up and out.

The doctor said that because of the retina surgeries at birth, the center of retina in left eye had moved by 20 deg and so he could not move his eye inwards only down a little.
BUT NOW>>>
The problem after the second operation in 2007 is that my son cannot focus as the left eye does not align with the right eye as it did before the surgery. The doctor has not given any definite answer to this yet and said that the eye is at a 30 deg deviation and he can only pull it 10 deg in so as not to cause double vision.
What does this mean doc? Why does my son’s left eye not be able to focus as it did before surgery. It is an embarrassment to him and I feel so guilty for exposing him to that second surgery.
ALSO another thing is that when he pulls a pencil closer to his nose at about 10 cm from the nose the left eye stops moving towards the center as his right eye would and and just stares straight ahead.
I discovered this just a few days ago and don’t understand it.
Please help with any advice you can.
Thankyou
Mrs Kapoor

[John C Hagan III, MD, FACS, FAAO]

I cannot tell you for sure. Generally with a history like this "good vision" is not possible with glasses;  It is not likely that the fovea will return to normal position and normal function.

JCH MD

[parkap]

Doc the situation with my son's eye has changed after we brought him to us.
He had ROP as an infant.... my history is in forst post but i will just repeat some.
He had ROP and v severe in left eye - his vision was 20/20 altho it was a lazy eye and totally suppressed by rt eye.

Apparantly he had macula edema which caused his left eye tht caused the vision to go to 20/200.
The doc said he needed a buckel and also laser for edema and has peeled and put in oil for now. He had cataract so his lens was also taken out but new one not put in yet. It has been three weeks and his vision is still bad in that eye.
If the edema removal improves sight should he not see clearly when he has his specson?
also
since his fovea had moved - macula dragging causing strabismus do u think once the scar has been peeled the fovea will move back?

[John C Hagan III, MD, FACS, FAAO]

Your son has a terribly difficult problem. 50 years ago he likely would be blind in both eyes. Your child's eyes do not work together and never will normally. Eye muscle surgery on cases like your son's are highly unpredictable and under correction, over correction and unexpected results are very common.

The most I could suggest would be to get a second and third opinion from strabismus surgery ophthalmologists about your next step. Unfortunately there is no guarentee of success, more surgery could make it worse and you may have to just "live with it".

Sorry I cannot be more encouraging. Do get the extra opinions. I hope I'm wrong.

JCH MD