Tied and Tidy: Closing the Conjunctiva Over Adjustable Sutures

Abstract

Background: Adjustable sutures have revolutionized strabismus surgery. Numerous techniques have been described that aim to facilitate postoperative adjustment. Nevertheless, some sort of procedure is always necessary following adjustable suture surgery and has to be arranged within 24 hours. Where no adjustment is required, the muscle needs to be secured at the existing position and the conjunctiva, sometimes left on a loop, has to be tidied up and sutured. Methods: As fewer than half of the operated on eyes need a final adjustment, we describe a technique whereupon the muscle is left on a loop and the conjunctiva is closed over it with two interrupted polyglactin 910 sutures. If an adjustment is deemed necessary, one of the sutures has to be cut and replaced at the end of the procedure. When the result of squint surgery is satisfactory and no muscle movement is needed, no further manipulation of the conjunctiva is required. Conclusions: In a series of 17 patients, we have found this technique to be excellent for patient comfort and time efficiency. We have not encountered any muscle slippage. We think that the ease of postoperative management may tend to bias the surgeon against adjustment. J Pediatr Ophthalmol Strabismus 2004;41:226-229 .

Single medial rectus muscle advancement in stretched scar consecutive exotropia

“…Limitation of adduction ranged from 0.0 to À3. 5. At surgery, the medial rectus muscle was found at a mean of 16.5 mm from the limbus and advanced a mean of 8.6 mm.…”

“…If the patients did not require adjustment, no further intervention was taken, and the knot was not interfered with. 5 If an adjustment was required, this was done on the same day of surgery (within approximately 7 hours). A postoperative orthoptic assessment was performed on the afternoon of surgery, and adjustment was carried out if an overcorrection of 20 D esotropia or more at distance was present.…”

Short Tag Noose Technique for Optional and Late Suture Adjustment in Strabismus Surgery

“…We describe a modification of the existing techniques of adjustable-suture strabismus surgery, [2][3][4][5][6][9][10][11][12][13][14][15][16] which we call the short tag noose adjustable technique. Saunders and O'Neil 11 devised a technique in which postoperative knot tying was required only in patients who underwent adjustment.…”

“…The sutures were left in the subconjunctival space to dissolve spontaneously if adjustment was not required. Kipioti et al 9 and Nguyen et al 18 also described variations in the bow-tie technique to eliminate a second procedure if adjustment was deemed unnecessary. Coats 19 described a technique in which he passed a "ripcord" suture around the muscle suture, pulling the muscle forward approximately 2 mm.…”

Delayed adjustable sutures: a multicentred clinical review

“…Taking this a step further by closing the conjunctiva in a permanent fashion to allow a delayed adjustment was initially described by Burns4 5 and then revisited by Granet and Banuelos6 and Nguyen et al 7. Stimulated by these reports, case series of adults8 9 and children10 have recently been published.…”