Adjustable suture strabismus surgery was introduced to improve results in unpredictable strabismus cases. However, its usage is increasing and in some centres is routine. The present authors propose that the routine use of the adjustable suture technique can only be justified if it can be shown to confer an advantage to the patient. In a retrospective analysis of matched data, they compared the results of their adjustable with non-adjustable strabismus surgery. The adjustable suture procedures performed during a 5-year period, on non-thyroid eye disease patients, were matched to non-adjustable cases according to the type and aetiology of strabismus and the magnitude of deviation. Pairs were matched as closely as possible according to age and strabismus surgery history. All cases were incomitant. The surgical results of the two groups were analysed with regard to the pre-operative and post-operative angles of deviation, the post-operative drift, and a successful outcome, pre-defined by carefully selected criteria. Twenty-six cases were analysed in each of the two groups. Mean pre- and post-operative angles of deviation showed no significant difference between the two groups. 'Success' rates were 81% in the adjustable group and 88% in the non-adjustable group. Given that the success rate of the two techniques is similarly high, a much larger study is required to detect a difference in results, with statistical significance. The authors conclude that there is currently insufficient evidence that patients, without thyroid eye disease, benefit from the longer and potentially uncomfortable procedure of adjustable suture strabismus surgery to support its rapidly growing use and that a prospective randomised controlled trial is indicated.

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The mechanism and the origin of the regioselectivity of the rhodium/diene-catalyzed ring-opening reactions of C1-substituted oxabenzonorbornadienes with arylboronic acids has been examined using hybrid density functional theory (DFT). The overall mechanism for the reaction is considered as a four-step reaction including transmetalation, carborhodation, β-oxygen elimination, and protonolysis. The free energy profiles show that the rate-determining step is involved in the protonolysis step which differs from previous mechanistic studies on metalcatalyzed ring-opening reactions of oxabenzonorbornadienes. Additionally, it is theorized the β-oxygen elimination step is the origin of regioselectivity. DFT calculations predict the formation of the 1,2,4-trisubstituted naphthalene framework is selective over the 1,1,2-trisubstituted product, in agreement with experimental observations.

We suggest that antero-posterior traction forces are the primary cause of full thickness macular holes, with these forces persisting in stage 3 and 4 macular holes, while tangential forces serve to enlarge the hole at this later stage.