Whenever strabismus surgery is mentioned, parents ask their doctors: Can the surgery cure them completely? This is a very nagging question that is genuinely difficult for doctors to answer. In fact, most strabismus surgeries are very effective and the eye position is correct. However, pediatric strabismus is complex and variable; and the outcome of surgery is affected by many factors, such as refractive problems, the child’s age, the development of fusion ability, and muscle development. Just like the growth of a child, strabismus is always changing. Therefore, parents often ask, “Why did my child’s original strabismus become an internal strabismus after surgery? Did the surgery fail or did the strabismus recur? “The cases of children who still have strabismus after surgery should be treated differently, so let’s analyze them one by one. What happens when an exotropia becomes an internal strabismus after surgery? Because intermittent exotropia and common exotropia are very prone to recurrence of exotropia after surgery, which is called strabismus regression. Therefore, the surgeon will take this into account when designing the surgical plan, and there will be a slight overcorrection of 5-10 trigeminal degrees in the early postoperative period, which is normal for the postoperative period and is used to compensate for the gradual regression. Over time, this small inward skew will gradually return, and parents should not worry too much about this situation and just review it closely. However, there are also children with abnormalities in brain innervation and fusion function, and the eye position will gradually become markedly inwardly skewed. In this case, early postoperative interventions such as alternating masking treatment, wearing distant vision lenses or trigeminal lenses, and suture adjustment if necessary, are performed. What happens when internal strabismus becomes exotropia after surgery? Some cases of internal strabismus may become exotropia after surgery, and it is difficult to return automatically after it appears. Therefore, it is often necessary to “undercorrect” the internal strabismus, that is, to leave a little bit of the internal strabismus. If exotropia develops after surgery, early suture adjustment is required. If the postoperative overcorrection is obvious in the long term, a second surgery is needed to correct the problem. What happens when the eye position is high and low after surgery? If the eye position is high and low after surgery, it may be that the eye position existed before surgery but was not detected and only became apparent after surgery; or it may be that during the healing process of the extraocular muscle, the position of the muscle attachment has shifted and is not attached to the normal position, so when the eye is pulled, the direction has changed; some children with strabismus, which is a vertical strabismus, have a high and low eye position before surgery and still have a high and low eye position after surgery In some children with vertical strabismus, the preoperative eye position is one high and one low, and after surgery, it is still one high and one low. Therefore, not all postoperative changes in eye position are recurrence of strabismus. Beijing Children’s Hospital has invented the “extraocular muscle adjustment suture surgery” to address the situation where the strabismus varies greatly after surgery. The suture adjustment ring is left on the operated extraocular muscle, and after surgery, the distance the extraocular muscle moves backward (posterior migration amount) can be controlled by pulling the suture adjustment ring to change the position of the eye and avoid secondary surgery. If overcorrected, the black suture loop can be pulled backward to reduce the amount of posterior migration of the muscle; if undercorrected, the black suture loop can be pulled forward to increase the amount of posterior migration. Adjusting the sutures can greatly reduce the probability of postoperative recurrence or overcorrection and undercorrection. However, there is still a certain percentage of recurrence possible.