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New suturing technique allows late or no adjustment after strabismus surgery
Arch Ophthalmol. 2009;127(12):1584-1590.
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A short tag noose suturing technique for strabismus surgery allows the omission or delay of second-stage suture adjustment if initial postoperative ocular alignment is satisfactory, a study showed.
"The short tag noose technique simplifies the logistics of suture adjustment and avoids the need for sedation in children who do not require adjustment," the study authors said. "The ability to delay the adjustment for days after surgery provides an option of additional intervention in patients who develop unexpected shifts in alignment in the days after surgery."
The suturing technique involves the replacement of long sutures with short tags that may be left under the conjunctiva after adjustment.
The retrospective study included the medical records of 120 strabismus procedures performed with the new suturing technique by one surgeon between January 2005 and December 2008. Surgical success was defined as residual deviation of less than 10 ΔD horizontal and less than 6 ΔD vertical. Investigators also reviewed complication and reoperation rates.
Study data showed that 27 procedures (22.5%) were performed in children and 97 procedures (80.8%) were performed in patients with complex strabismus. The mean follow-up interval was 6 months.
Results at 2 months showed success rates of 81% for horizontal strabismus and 70.7% for vertical strabismus. Success rates in patients adjusted 2 days or longer after surgery were similar to overall rates.
Reoperation rates were 10% for horizontal strabismus and 19% for vertical strabismus.
The short tag noose slipped in one procedure and was corrected by readjustment 4 days after surgery. Two patients required the removal of cysts or granulomas, the authors said.