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Releasable sutures aid outcome of pediatric strabismus surgery
In a study, 94% of patients had their esotropia aligned within 10 PD of target.
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WASHINGTON — Releasable sutures can improve the results of pediatric strabismus surgery, said Ossama M. Hakim, FRCS, at the annual meeting of the American Association for Pediatric Ophthalmology and Strabismus.
In a study led by Dr. Hakim at the El-Maghraby Eye & Ear Hospital in Jidda, Saudi Arabia, 50 esotropic children underwent strabismus surgery for bilateral medial rectus recession with releasable adjustable sutures.
“After bilateral medial rectus recession, residual esotropia is a significant problem for children,” Dr. Hakim told meeting attendees. “Standard adjustable sutures often do not remedy the problem, making it difficult to correct.”
Dr. Hakim and colleagues used releasable adjustable sutures to correct residual esotropia after strabismus surgery.
Releasable technique
In the study, the muscle was recessed 1.5 mm to 2 mm and sutured to the sclera at a predetermined position. A second releasable suture was placed at the insertion site of the first suture and tied in a strengthened loop knot beneath the first suture. The second suture was placed to advance the recessed muscle to the new scleral insertion. Surgeons tucked the remaining loop end into the inferior fornix.
“If undercorrection was detected at 1 day postop, the releasable suture was pulled out to provide additional muscle recession,” Dr. Hakim said. Patients were sedated with intranasal midazolam before the suture adjustment.
Before surgery, patients ranging in age from 10 to 94 months had a standard deviation of 20 to 60 
D with a mean of 33 D. Researchers followed patients for 1 to 12 weeks postoperatively to measure standard deviation and residual esotropia.
The releasable adjustable suture technique was considered successful if patients’ esodeviation was aligned within 10 D of target.
Successful alignment
Thirty-two patients (64%) were successfully aligned after surgery, Dr. Hakim said.
Eighteen patients (36%) were undercorrected with a residual angle of 14 D to 25 D (mean 18 D). After sutures were released in these patients, 15 (83%) were successfully aligned according to study protocol. Three children remained undercorrected.
“Our success rate was very high,” Dr. Hakim said. “We feel that we have found a viable alternative to adjustable sutures.”
In total, alignment improved within 10 D of targeted deviation in 47 patients (94%). “This new releasable adjustable suture technique helps surgeons to attempt bilateral medial rectus recession in children without reservations,” he said.
“It gives surgeons a second chance during the postoperative period to realign the eyes and increase the outcome of strabismus surgery by more than 90%,” he added.
For Your Information:
- Ossama M. Hakim, FRCS, can be reached at the El-Maghraby Eye & Ear Hospital, Khozzam Street, Kilo 3, Jidda 21462, Saudi Arabia; 996-2-636-9052; fax: 996-2-636-1420; e-mail: oshakim@hotmail.com.