Adjustable suturing aids outcome of strabismus surgery in children, adults

WASHINGTON — Adjustable suturing can improve the outcome of strabismus surgery in both children and adults, two studies presented here concluded.

At the annual meeting of the American Association for Pediatric Ophthalmology and Strabismus, Ossama M. Hakim, FRCS, of the Maghraby Eye Hospital in Jeddah, Saudi Arabia, presented the outcomes of 50 esotropic children who underwent bilateral medial rectus recession with adjustable sutures.

Patients aged 10 to 94 months, with a standard deviation of 20 to 60 prism diopters (PD), underwent surgery. During the procedure, the medial rectus muscle was recessed 1.5 mm to 2 mm and sutured to the sclera. A second releasable suture was tied in a strengthened loop beneath the first suture. If undercorrection was detected at 1 day postop, the releasable suture was pulled to provide additional muscle recession.

Sixty-four percent of patients had successful alignment following surgery. Thirty-six percent of patients were undercorrected with a residual angle of 14 PD to 25 PD. After sutures were released in these patients, 83% were successfully aligned.

In another study, Lelia M. Khazaeni, MD, and colleagues at the Scheie Eye Institute in Philadelphia reviewed the charts of 60 adult patients who received medial rectus recession/resection for exotropia between 1998 to 2003.

Patients underwent recession/resection of the medial rectus muscle by 1 mm, with a 1-mm hangback for adjustability. This technique allowed 93% of patients to achieve alignment within 10 PD of orthophoria.

Following surgery, most patients exhibited esodeviation when glancing away from the medial rectus muscle. This slight esodeviation in patients guarded against the recurrence of exotropia, Dr. Khazaeni said.

“The adjustable sutures allowed for esodeviation and helped to prevent recurrent exotropia,” she said. Additionally, she said, the sutures aided in providing precision for the correction of refractive errors.