Ripcord Adjustable Suture Technique for Use in Strabismus Surgery

Abstract

djustable sutures in strabismus surgery may be difficult or impossible in poorly cooperative patients. An adjunct suture technique that allows a 1-step, all-or-nothing, preprogrammed adjustment in patients not considered good candidates for standard postoperative adjustable sutures is described. Twelve patients underwent adjustable strabismus surgery using the ripcord technique. Six patients had unacceptable alignment after surgery. In 5 of these, alignment was successfully adjusted. The ripcord adjustable suture technique is effective and is well tolerated by patients.

Adjustable sutures in children using a modified technique

“…This is a major advantage because the majority of patients undergoing adjustable sutures do not require adjustment. 5,[11][12][13][14][15] Our results compare favorably with other reports on the use of adjustable sutures in children. In our study, 88% of our patients were within 10 PD of orthophoria at their final postoperative visit.…”

Adjustable sutures in children using a modified technique

“…This is a major advantage because the majority of patients undergoing adjustable sutures do not require adjustment. 5,[11][12][13][14][15] Our results compare favorably with other reports on the use of adjustable sutures in children. In our study, 88% of our patients were within 10 PD of orthophoria at their final postoperative visit.…”

Adjustable suture strabismus surgery

“…Hakim et al 44 described a releasable adjustable suture technique for medial rectus recessions, which allowed 2 mm or more of adjustment when the suture was released. Coats 45 described a ripcord adjustable suture technique, which allowed for a one time, single-stage adjustment of recessed or resected muscles in a predetermined, all-or-nothing step by releasing an 'adjunct suture' (separate from the pole sutures) to increase the recession (or decrease the resection) if required. The disadvantage of the techniques of Hakim et al and Coats is that they do not allow titration of postoperative adjustment.…”

Surgical outcomes of adjustment on recessed lateral rectus muscle versus resected medial rectus muscle for intermittent exotropia

“…Since the popularization of the adjustment surgery in the 1970s [ 2 , 10 ], many studies have addressed adjustment and focused on introducing different adjustment techniques [ 3 , 11 , 12 ] or demonstrating the effectiveness of the adjustment technique itself by comparing surgical results between adjustment and no adjustment groups [ 13 , 14 ]. In addition, some studies focused specifically on conditions such as adjustment to thyroid-associated strabismus [ 15 ] or all types of strabismus including exotropia, esotropia, and vertical strabismus [ 9 , 16 ].…”

“…There is considerable literature addressing resected muscle adjustment [ 8 , 9 , 12 ]. Hong et al [ 8 ] reported that they resected the rectus muscle and adjusted it in patients with sensory exotropia.…”

Adjustable sutures in children using a modified technique

“…This is a major advantage because the majority of patients undergoing adjustable sutures do not require adjustment. 5,[11][12][13][14][15] Our results compare favorably with other reports on the use of adjustable sutures in children. In our study, 88% of our patients were within 10 PD of orthophoria at their final postoperative visit.…”

Adjustable suture strabismus surgery

“…Hakim et al 44 described a releasable adjustable suture technique for medial rectus recessions, which allowed 2 mm or more of adjustment when the suture was released. Coats 45 described a ripcord adjustable suture technique, which allowed for a one time, single-stage adjustment of recessed or resected muscles in a predetermined, all-or-nothing step by releasing an 'adjunct suture' (separate from the pole sutures) to increase the recession (or decrease the resection) if required. The disadvantage of the techniques of Hakim et al and Coats is that they do not allow titration of postoperative adjustment.…”

Surgical outcomes of adjustment on recessed lateral rectus muscle versus resected medial rectus muscle for intermittent exotropia

“…Since the popularization of the adjustment surgery in the 1970s [ 2 , 10 ], many studies have addressed adjustment and focused on introducing different adjustment techniques [ 3 , 11 , 12 ] or demonstrating the effectiveness of the adjustment technique itself by comparing surgical results between adjustment and no adjustment groups [ 13 , 14 ]. In addition, some studies focused specifically on conditions such as adjustment to thyroid-associated strabismus [ 15 ] or all types of strabismus including exotropia, esotropia, and vertical strabismus [ 9 , 16 ].…”

“…There is considerable literature addressing resected muscle adjustment [ 8 , 9 , 12 ]. Hong et al [ 8 ] reported that they resected the rectus muscle and adjusted it in patients with sensory exotropia.…”

Adjustable sutures in children using a modified technique

“…This is a major advantage because the majority of patients undergoing adjustable sutures do not require adjustment. 5,[11][12][13][14][15] Our results compare favorably with other reports on the use of adjustable sutures in children. In our study, 88% of our patients were within 10 PD of orthophoria at their final postoperative visit.…”

Adjustable suture strabismus surgery

“…Hakim et al 44 described a releasable adjustable suture technique for medial rectus recessions, which allowed 2 mm or more of adjustment when the suture was released. Coats 45 described a ripcord adjustable suture technique, which allowed for a one time, single-stage adjustment of recessed or resected muscles in a predetermined, all-or-nothing step by releasing an 'adjunct suture' (separate from the pole sutures) to increase the recession (or decrease the resection) if required. The disadvantage of the techniques of Hakim et al and Coats is that they do not allow titration of postoperative adjustment.…”

Surgical outcomes of adjustment on recessed lateral rectus muscle versus resected medial rectus muscle for intermittent exotropia

“…Since the popularization of the adjustment surgery in the 1970s [ 2 , 10 ], many studies have addressed adjustment and focused on introducing different adjustment techniques [ 3 , 11 , 12 ] or demonstrating the effectiveness of the adjustment technique itself by comparing surgical results between adjustment and no adjustment groups [ 13 , 14 ]. In addition, some studies focused specifically on conditions such as adjustment to thyroid-associated strabismus [ 15 ] or all types of strabismus including exotropia, esotropia, and vertical strabismus [ 9 , 16 ].…”

“…There is considerable literature addressing resected muscle adjustment [ 8 , 9 , 12 ]. Hong et al [ 8 ] reported that they resected the rectus muscle and adjusted it in patients with sensory exotropia.…”