The Tutopatch® assisted surgery for complex strabismus study: <scp>TASCS</scp> ‐study

PURPOSE: To investigate the efficacy of tendon elongation using bovine pericardium (Tutopatch®) in complex strabismus surgeries, with a specific focus on longer follow-up of postoperative outcomes and patient satisfaction. METHODS: In this pre-post cohort study, the records of all patients who underwent tendon elongation strabismus surgery with Tutopatch® at Radboudumc and Amsterdam UMC were retrospectively reviewed. Eligible patients were invited for a single prospective follow-up visit to assess long-term outcomes. Strabismus angle (success defined as ≤5.71° of orthotropia) and duction limitations (converted to a pseudo-quantitative scale ranging from 0 to 5) were evaluated preoperatively, 1 week postoperatively, 3 months postoperatively and at longer intervals where possible. Patient satisfaction was measured on a Visual Analogue Scale at the prospective follow-up. RESULTS: Sixty-nine participants (mean age 41.3 ± 18.4 years) were included. Fifty-one patients had childhood onset and eighteen patients had acquired onset of strabismus. Tutopatch® was predominantly used to correct the horizontal deviation. Long-term follow-up data (>17.4 weeks) were available for 49 patients (71%), with a median follow-up of 124 weeks (range 19.9-431 weeks) and surgical success was achieved in 73% (near) and 60% (distance). Duction limitations significantly increased postoperatively, especially in exodeviations, but improved over time and seemed to have minimal impact on ocular alignment in primary position. Patient satisfaction was very high (median VAS 9.0), with only weak-to-moderate correlation with ocular alignment. CONCLUSION: Tutopatch® is a viable surgical option for tendon elongation in complex strabismus cases with favorable long-term ocular alignment, mild duction limitation and high patient satisfaction.