Adjustable suture strabismus surgery in infants and children: a 19-year experience

Kassem, Ahmed M.; Xue, Gilbert; Gandhi, Niral B.; Tian, Jing; Guyton, David L.

doi:10.1016/j.jaapos.2018.01.013

Cited by 12 publications

(5 citation statements)

References 8 publications

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“…A large study by Kassem et al (n = 637 patients) showed the superiority of AS over NAS in achieving the expected postoperative deviation [19]. On the other hand, the aforementioned RCT by Kamal et al did not prove that effect, although their sample population was much smaller (n = 60 patients) [7].…”

Section: Reoperation Ratementioning

confidence: 96%

Adjustable Versus Nonadjustable Sutures in Strabismus Surgery—Who Benefits the Most?

Gawęcki¹

2020

JCM

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Background: Adjustable sutures have been used in strabismus surgery for more than 40 years, but controversy remains regarding their application. This review sought to analyze studies comparing the efficacy of adjustable sutures (AS) and nonadjustable sutures (NAS) in the treatment of different ocular deviations. Materials and Methods: The PubMed literature database was searched using the keywords ‘adjustable sutures’ and ‘strabismus surgery’, yielding a total of 209 results. Only comparative studies were extracted, and the results were divided into three categories: Adult comitant strabismus, childhood comitant strabismus, and paretic/restrictive strabismus. Results: The search revealed eleven comparative studies on AS versus NAS in adult strabismus, including only one randomized controlled trial. Five of these studies analyzed just the postoperative success rate, three studies analyzed just the reoperation rate, two studies analyzed both the postoperative success and reoperation rates, and one study evaluated achievement of the postoperative target angle. Three of seven studies analyzing postoperative success reported the statically significant superiority of AS over NAS, while four of five studies analyzing reoperation rate indicated a significantly smaller percentage of reoperations with the use of AS. The study covering postoperative target angle as an outcome favored the AS technique. Separately, the search revealed three comparative studies on AS versus NAS in childhood strabismus, one of which reported a statistically significant advantage with AS. Only four comparative studies on AS versus NAS in paretic or restrictive strabismus were found; all showed a tendency for better results with the use of AS but not in a statistically significant fashion. Overall, out of 18 studies analyzed in this review, 17 suggested better clinical results followed the application of AS versus NAS; however, only a minority had statistically significant results. Conclusion: The analysis of available research failed to support AS as the preferable surgery technique over NAS in cases of simple and predictive strabismus. Further research is needed to more precisely determine the group of patients able to benefit the most from AS.

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Section: Reoperation Ratementioning

confidence: 96%

Adjustable Versus Nonadjustable Sutures in Strabismus Surgery—Who Benefits the Most?

Gawęcki¹

2020

JCM

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“…[8] Other studies have shown that the use of adjustable sutures improves success and reduces resurgery rates for horizontal recti. [129] Only two patients in the esotropia group and no patient in the exotropia group had a significant residual deviation at 1-month review. This increased to five patients (esotropia group) at the last review.…”

Section: Discussionmentioning

confidence: 99%

Outcome of delayed adjustable strabismus surgery in children using a bow-tie optional adjustable technique

Muralidhar¹,

Churawan²,

Sekar³

et al. 2019

Indian J Ophthalmol

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Purpose: The aim of this article is to study the feasibility of a delayed adjustable technique of strabismus surgery in children using an optional adjustable suture technique. Methods: The retrospective study included patients <12 years of age. Recessions were done using an optional adjustable bow-tie technique and resections were done by the conventional technique. Patients were evaluated on the third postoperative day and adjustments done when needed. Statistical analysis was done using Microsoft Excel 2010®. Results: The study included 11 patients with exotropia and 16 patients with esotropia. The mean age of the patients was 5.2 years (range 1–11 years). The mean preoperative distance deviation was 46.7 ± 10.4 prism diopters (PD) for exotropic patients and 47.1 ± 16.9 PD for esotropic patients. The mean preoperative near deviation was 46.6 ± 11 PD for exotropic patients and 52.4 ± 17.1 PD for esotropia. Two patients with exotropia (18.2%) and four patients with esotropia (25%) were adjusted under intravenous ketamine in the operating room under anesthetist supervision. No difficulty was encountered in advancing/recessing the muscles. The success rate at 1 month was 100% for exotropia and 87.5% for esotropia. The success rate at the final follow-up was 81.8% for patients with exotropia and 68.7% for patients with esotropia. Conclusions: This delayed optional adjustable strabismus surgery technique provides good short-term results and lower adjustment rates.

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“…Kassem et al 26 provided a follow-up study to Awadein et al 10 from the same institution and same strabismus surgeon in an effort to further determine the efficacy of adjustable sutures in children. The study added 8 additional years compared with the earlier study and expanded the inclusion criteria to consider children who were 15 years of age and younger.…”

Section: Pediatric-specific Studies (<18 Years)mentioning

confidence: 99%

“…[28][29][30][31] Level II Studies. Kassem et al 26 (discussed above in the "Motor Alignment Outcomes" section) focused on pediatric patients aged 15 years and less undergoing horizontal strabismus surgery. Reoperations occurred between 6 months and 10 years after the primary surgery, and there was a statistically significant lower rate of reoperation that occurred among those patients who underwent adjustable suture placement (15%) compared with the nonadjustable group (21%, P ¼ 0.033).…”

Section: Reoperation Ratesmentioning

confidence: 99%

Adjustable Sutures in the Treatment of Strabismus

et al. 2022

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Purpose: To review the scientific literature that evaluates the effectiveness of adjustable sutures in the management of strabismus for adult and pediatric patients.Methods: Literature searches were performed in the PubMed database through April 2021 with no date limitations and were restricted to publications in English. The searches identified 551 relevant citations, of which 55 were reviewed in full text. Of these, 17 articles met the inclusion criteria and were assigned a level of evidence rating by the panel methodologist. The search included all randomized controlled studies regardless of study size and cohort studies of 100 or more patients comparing the adjustable versus nonadjustable suture technique, with a focus on motor alignment outcomes or reoperation rates.Results: The literature search yielded no level I studies. Of the 17 articles that met the inclusion criteria, 11 were rated level II and 6 were rated level III. Among the 12 studies that focused on motor alignment outcomes, 4 small randomized clinical trials (RCTs) did not find a statistically significant difference between groups, although they were powered to detect only very large differences. Seven of 8 nonrandomized studies found a statistically significant difference in motor alignment success in favor of the adjustable suture technique, both overall and in certain subgroups of patients. Successful motor alignment was seen in both exotropia (in 3 studies that were not limited to children) and esotropia (in 1 study of adults and 2 of children). The majority of included studies that reported on reoperation rates found the rates to be lower in patients who underwent strabismus surgery with adjustable sutures, but this finding was not uniformly demonstrated.Conclusions: Although there are no level I studies evaluating the effectiveness of adjustable sutures for strabismus surgery, the majority of nonrandomized studies that met the inclusion criteria for this assessment reported an advantage of the adjustable suture technique over the nonadjustable technique with respect to motor alignment outcomes. This finding was not uniformly demonstrated among all studies reviewed and warrants further investigation in the development and analysis of adjustable suture techniques. Ophthalmology 2021;-:1e11 ª 2021 by the American Academy of Ophthalmology

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Adjustable suture strabismus surgery in infants and children: a 19-year experience

Cited by 12 publications

References 8 publications

Adjustable Versus Nonadjustable Sutures in Strabismus Surgery—Who Benefits the Most?

Adjustable Versus Nonadjustable Sutures in Strabismus Surgery—Who Benefits the Most?

Outcome of delayed adjustable strabismus surgery in children using a bow-tie optional adjustable technique

Adjustable Sutures in the Treatment of Strabismus

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