Adjustable sutures help improve strabismus surgery

Las Vegas-Modern adjustable suture techniques in strabismus surgery are a significant improvement over those that were used when the technique was first described more than half a century ago, and any of the extraocular muscles now can be adjusted, said David L. Guyton, MD, in a presentation during the American Academy of Ophthalmology annual meeting.

Adjustable sutures allow postoperative adjustment of the effect of surgery to improve the final outcome. Studies have shown that strabismus surgery with adjustable sutures yields success rates that are about 10 percentage points higher than when performed with standard sutures, explained Dr. Guyton, the Krieger professor of pediatric ophthalmology and director of the Krieger Children's Eye Center at the Wilmer Institute, Baltimore.

In adjustable superior oblique surgery, two strands of a permanent 6-0 polyester suture separate the two cut ends of the tendon, with a sliding noose for adjustment. This technique was described by Dr. Guyton and his colleagues in the journal Strabismus in 2005.

"The superior oblique tendon is underneath the upper lid, and you would think that you would want to have the patient look down to get to it, but looking down tightens the tendon, and you cannot pull it forward for proper access," he said. "If the patient looks straight ahead or up, though, you can gain easy access to the ends of the tendon."

"Always before, the sliding knot along the suture was left behind, and it took a while for the body to absorb it," Dr. Guyton said. "We developed a way to remove the noose at the end of adjustment so the body would not have to contend with all of that extra suture material under the tissue, and the wound would heal faster and be more comfortable."