Comment on: Learning curves for strabismus surgery in two ophthalmologists.

Sir,

We congratulate authors Kim et al.[1] for documenting the learning curve in strabismus surgery. As I used to be and I am still in charge at the hospitals which grant diverse strabismus surgery training, I would like to make certain evaluations. It is stated that in this study, two surgeons with the ocular surgery experience on different subjects gained experience in horizontal strabismus muscle surgery after 40–50 cases, but complication developed in one case of each surgeon. Scleral perforation may occur even in those with ocular surgery experience, and therefore, critical points in strabismus surgery should be given to the assistants or specialists before the surgical experience in the surgical training. It should be kept in mind that claims in the field of strabismus were infrequent but associated with higher average indemnity payments relative to other ophthalmology fields.[2]

As stated in the learning curve of endoscopic dacryocystorhinostomy surgery performed by Malhotra et al., giving the practical leading points before the surgery and video record analysis of the operations will contribute to the learning curve of the cases.[3] We would like to ask the writers the complications of both two surgeons developed at which case and at which stage and whether the abduction problem in the case operated by the surgeon B is related to the restriction. Another issue is whether operation microscope or surgical binocular loupe was used or not in strabismus surgery. The reason for the surgery duration of the surgeon B to be longer in the study might be that the surgeon B implemented unilateral medial rectus resection and lateral rectus recession in more patients and also the patient age group was composed of younger cases and the person who performed the retina surgery felt safer and acted more rapidly.

Therefore, a study to be carried out among the assistants scrutinizing the learning curve of strabismus surgery may give more diverse results. The most important factor affecting the surgical results in the treatment of strabismus patients is the preoperative evaluation of the patient. Afterward, the success of the surgical technique applied is of importance.

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