Comparison of the Stability of Postoperative Alignment in Sensory Exotropia: Adjustable Versus Non-Adjustable Surgery

Abstract

PurposeTo compare the success rates and stabilities of postoperative alignment between adjustable and the non-adjustable surgeries in the treatment of sensory exotropia.MethodsA retrospective analysis was performed on all patients with sensory exotropia who had undergone unilateral lateral rectus recession and medial rectus resection (R&R) between January 1998 and August 2005. Thirty-four patients underwent conventional R&R, and 20 patients underwent R&R with adjustable suture of the lateral rectus. The surgical results between the two groups were analyzed with regard to the preoperative and post-operative deviation angles and the postoperative drift. The postoperative deviation angle was measured on postoperative day 1 as well as at two weeks, three months, six months and the final visit after surgery.ResultsThere were no statistically significant differences in the mean preoperative and postoperative deviation angles between the two groups. In 30 (88%) patients in the non-adjustable group and 15 (75%) patients in the adjustable group, postoperative deviation was less than 15 prism diopters (PD) at the three month follow-up. There was no significant difference in the mean postoperative drift between the two groups.ConclusionsStrabismus surgery with adjustable sutures did not show a significantly better result than surgery without adjustable sutures in the treatment of sensory exotropia. Considering the amount of postoperative exodrift in both groups, we postulate that the immediate ocular alignment after surgery for sensory exotropia should be orthophoric or 5-6 PD of esodeviation.

Adjustable suture strabismus surgery

“…[4][5][6][7][8][9][10][11] Some studies report no advantage of adjustable sutures. Park et al 12 found that strabismus surgery with adjustable sutures (n ¼ 20) did not show significantly better results than surgery without adjustable sutures (n ¼ 34) in the treatment of sensory exotropia. Bishop and Doran 13 found an equally high success rate in adjustable and non-adjustable suture groups (81% vs 88%) in their retrospective case-matched study of 52 cases.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13][14] Most authors agree that adjustable sutures are indicated when the surgical outcome is unpredictable. 2,11 Other authors feel that these indications are too restrictive: Tripathi et al 11 and others recommend adjustable suture strabismus surgery as 'the procedure of choice for all patients who are willing to cooperate.…”

“…There are minor variations in the technique of adjustable sutures used by various surgeons; [4][5][6][7][8][9][10][11][12][13] however, the principles of the technique remain constant.…”

Adjustableversusnon-adjustable suture techniques for concomitant horizontal strabismus: a comparative study

“…The authors emphasized the need for a larger number of patients in each group. In 2009, Park et al (18) could not show any significant differences between the results when comparing adjustable and non-adjustable surgery in the treatment of 54 patients with sensory exotropia. In a larger group comprising 370 patients with horizontal strabismus (primary and re-operation cases), Kraft et al (19) , found that XT patients who underwent adjustable surgery had a significant 15% in success rate compared to patients undergoing non-adjustable surgery.…”

Az Gören Olgularda Şaşılık Cerrahisi

“…10,12 Cerrahi sonrası uzun dönemde paralelliğin korunması, özellikle az gören ve füzyon potansiyeli olmayan ET olgularında ardıl kaymanın gelişmemesi için az düzeltme, XT olgularında ET olgularından farklı olarak fazla düzeltme gerektiği ileri sürülmektedir. 6,16,17 Sonucu tahmin edilemeyecek bu tip olgularda ayarlanabilir sütür cerrahisi bir seçenek olmakla birlikte Park ve arkadaşlarının 18 duyusal XT'li olgularda yaptıkları karşılaştırılmalı çalışmada başarı oranları arasında istatistiksel anlamda bir fark olmadığı bildirilmiştir.…”