Surgical management of strabismus remains a challenge because surgical success rates, short-term and long-term, are not ideal. Adjustable suture strabismus surgery has been available for decades as a tool to potentially enhance the surgical outcomes. Intellectually, it seems logical that having a second chance to improve the outcome of a strabismus procedure should increase the overall success rate and reduce the reoperation rate. Yet, adjustable suture surgery has not gained universal acceptance, partly because Level 1 evidence of its advantages is lacking, and partly because the learning curve for accurate decision making during suture adjustment may span a decade or more. In this review we describe the indications, techniques, and published results of adjustable suture surgery. We will discuss the option of ‘no adjustment' in cases with satisfactory alignment with emphasis on recent advances allowing for delayed adjustment. The use of adjustable sutures in special circumstances will also be reviewed. Consistently improved outcomes in the adjustable arm of nearly all retrospective studies support the advantage of the adjustable option, and strabismus surgeons are advised to become facile in the application of this approach.
Background Strabismus, or squint, can be defined as a deviation from perfect ocular alignment and can be classified in many ways according to its aetiology and presentation. Treatment can be broadly divided into medical and surgical options, with a variety of surgical techniques being available, including the use of adjustable or non-adjustable sutures for the extraocular muscles. There exists an uncertainty as to which of these techniques produces a better surgical outcome, and also an opinion ...
PURPOSE: To analyze the practical aspects and advantages of one-stage adjustable surgery under topical anesthesia in concomitant horizontal strabismus. METHODS: A retrospective review of 363 patients was completed to assess (1) the frequency of need to perform adjustment, (2) the amount and pattern of adjustment, and (3) the final alignment at least 6 months after surgery. Intraoperative adjustment was performed strictly toward the aim of orthophoria or slight overcorrection (heterophoria < 6 pr...
Purpose To characterise the results of the largest patient series to date undergoing closed conjunctival delayed adjustable suture techniques. Methods A multicentre retrospective review of 440 operations (patients aged 10–91 years) by five surgeons at four centres were evaluated for surgical outcomes associated with the delayed adjustable suture technique. Results 26% (116 of 440) of all patients required postoperative manipulation, with individual surgeon rates ranging from 13% to 56%. The majo...
Abstract Objective: To describe a new, adjustable suture technique for strabismus surgery that is safe and effective and allows for adjustment during the postoperative week only when required. Design: Retrospective review. Participants: A total of 304 patients, of which 149 were male and 155 female, with an age range from 4 to 89 years and a median age of 42 years. Methods: All patients treated with the short adjustable suture technique between September 2007 and April 2009 were reviewed retrosp...
Background Some authors have suggested that a posterior fixation suture on the lateral rectus muscle is ineffective because of the muscle's long arc of contact with the globe. We report a small case series of patients successfully treated using a lateral rectus posterior fixation suture. Methods The surgical database of one surgeon (JMH) was reviewed for all patients undergoing lateral rectus posterior fixation surgery for mechanical or paretic strabismus. In all cases, the lateral rectus muscle...
There is no randomized, controlled trial (RCT) supporting the contention that evidence-based medicine is beneficial, and “evidence” is more than the information that can be obtained from RCTs. Systematic reviews have severe limitations of scope and reach, and RCTs can lead to false or contradictory conclusions. Most controlled studies enroll only highly selected groups of patients, specifically excluding those with complicating factors, yet real patients bring with them an abundance of messy het...
#1Yong Chul Park(KNU: Kyungpook National University)H-Index: 1
#2Bo Young Chun(KNU: Kyungpook National University)H-Index: 6
Last. Jung Yoon Kwon(KNU: Kyungpook National University)H-Index: 4
view all 3 authors...
Purpose: To compare the success rates and stabilities of postoperative alignment between adjustable and the non-adjustable surgeries in the treatment of sensory exotropia. Methods: A retrospective analysis was performed on all patients with sensory exotropia who had undergone unilateral lateral rectus recession and medial rectus resection (RR23:277-280 ⓒ 2009 by the Korean Ophthalmological Society.
Purpose To determine the duration of postoperative conjunctival injection following strabismus surgery and to assess how this is affected by previous extraocular muscle surgery. This would improve preoperative counseling of strabismus patients. Methods Subjective evaluation of conjunctival redness based on patient questionnaire response. Results Fifty-three patients returned completed questionnaires. A total of 93 muscles were operated on. Of these, 46 had not undergone previous operations; 47 h...
Strabismus is an eye disease that affects about 0.12%-9.86% of the population, which can cause irreversible sensory damage to vision and psychological problems. The most severe cases require surgical intervention, despite other less invasive techniques being available for a more conservative approach. As for surgeries, the treatment goal is to align the eyes to recover binocular vision, which demands knowledge, training, and experience. One of the leading causes of failure is human error during ...
Last. Brian Harrisberg(RPA: Royal Prince Alfred Hospital)H-Index: 6
view all 4 authors...
Thyroid eye disease is an autoimmune inflammatory disorder of the orbit in adults. It causes inflammation, expansion and fibrosis of orbital fat, muscles and the lacrimal gland, leading to facial d...
Last. Linda R. Dagi(Boston Children's Hospital)H-Index: 16
view all 6 authors...
Abstract Purpose To report the incidence of symptomatic vertical and torsional diplopia after superior rectus transposition (SRT) for esotropic Duane syndrome and abducens nerve palsy. Methods The medical records of patients with esotropic Duane syndrome or abducens nerve palsy seen at Boston Children’s Hospital (2006-2018) and treated with unilateral SRT with or without augmentation was performed. The primary outcome was incidence of postoperative vertical or torsional diplopia in primary posit...
Last. Peter Kam(USYD: University of Sydney)H-Index: 42
view all 4 authors...
Strabismus correction surgery is the most common eye operation in children. Adults have approximately a 4% lifetime risk of developing strabismus. Current treatment options include pharmacological injection of botulinum toxin or bupivacaine, conventional corrective surgery, adjustable suture surgery and minimally invasive surgery. Repeated surgery is common as each operation has a 60%-80% chance of successful correction. The benefits of early surgical correction in large-angle strabismus in chil...
Last. John W. Simon(Albany Medical College)H-Index: 26
view all 6 authors...
INTRODUCTION Previous series suggest adjustable sutures (AS) in adult strabismus surgery yield improved ocular alignment and better success rates compared to nonadjustable sutures (NAS). We questioned whether these differences are clinically significant and whether they justify the added time and discomfort required for AS. METHODS We reviewed all available records of adults undergoing horizontal strabismus surgery by the last two authors between 2000 and 2014. Independently, the two surgeons de...
#1Sana Nadeem(FUI: Foundation University, Islamabad)
Purpose: To assess the pain experienced by patients at the time of suture adjustment using topical proparacaine hydrochloride 0.5% anesthesia, in adjustable suture strabismus surgery. Study Design: Prospective, interventional study. Place and Duration of Study: Eye department of Fauji Foundation Hospital, Rawalpindi from May, 2017 to March, 2019. Material and Methods: A prospective study was carried out to assess the pain experience of patients undergoing suture adjustment under topical proparac...
PURPOSE: To evaluate strabismus surgery with intraoperative adjustment of sutures under topical anesthesia in children. METHODS: Nineteen children with horizontal deviation underwent a one-stage surgical technique performed under topical anesthesia. Surgery consisted of unilateral or bilateral recession and/or resection of horizontal muscles or the medial or lateral rectus muscles, with intraoperative adjustment of sutures based on alternate prism cover test. Follow-up was done at 1 day and 1, 3...