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Adjustable sutures may improve success rate of realignment in pediatric strabismus surgery
J AAPOS. 2008;12(6):585-590.
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In children 10 years of age and younger, adjustable sutures in strabismus surgery appear to improve success rates.
The retrospective, controlled study, which looked at 298 cases of horizontal eye muscle surgery using an adjustable suture and 98 cases using a non-adjustable suture, found a statistically significant difference (P < .01) in success rates favoring the adjustable suture.
In the adjustable suture group, angle of deviation was measured 1 to 2 hours postoperatively, and adjustment was made in 189 of 297 cases (64%). One child could not be assessed, and the adjustable sutures were tied off without adjustment. Adjustments were made using topical proparacaine or intravenous propofol.
At 3 months postop, satisfactory horizontal alignment was achieved in 64.5% and 79% of non-adjustable and adjustable cases, respectively.
"Although postoperative complications such as suture reactions, discomfort, slipped muscles and so forth were not specifically tabulated, we had no impression that these were different in frequency between the two groups," the study authors said.
As a pediatric ophthalmologist in private practice for over 20 years, I want to commend the authors for the size of their study and for the supporting cast that allows them to perform the volume of these procedures at their institution. The major criticism that I have with this study is that the follow-up time where success is measured is at 3 months postop. While a patient might be a “success” at 3 months, it is months and years later that ultimately define success. I have personally seen patients younger than 10 years of age in my practice who have undergone adjustable suture strabismus surgery by several centers around the country and have required re-operations. I certainly agree that a prospective, case-controlled study would be necessary to assess the long-term success rate of adjustable vs. non-adjustable surgery. In the meantime, strabismus surgeons will continue to perform surgery in their own comfort zone.
- Robert S. Gold, MD
OSN Pediatrics/Strabismus Section Editor