Delayed Adjustment of Short Tag Noose Sutures in Strabismus Surgery Allows the Effect of Surgery to be Evaluated in Real Time Up to 7 days, Thus Reducing the Numbers Needed to Adjust
Claes S. Lønkvist, MD; Tobias Torp-Pedersen, MD, PhD; Jon Peiter Saunte, MD
Dept. of Ophthalmology, Rigshospitalet, University of Copenhagen, Denmark
Introduction: Adjustable sutures in strabismus surgery provides the surgeon an extra tool in order optimize the ocular alignment after the initial surgery depending on the effect on deviation in the individual patient. Short tag noose sutures hidden under conjunctiva may be adjusted up to 7 days after primary surgery. (Granet et al)
Methods: Retrospective evaluation of all patients treated by strabismus surgery during a 5-month period from January 1st 2017 to May 31st 2017 by 3 strabismus surgeons in one University Clinic by chart review. We evaluated all patients with adjustable sutures, time at adjustment from surgery, any spontaneous change in alignment during the first post-op week which could remove the indication for suture adjustment, and any complications.
Results: 72 of 251 (29%) had adjustable sutures applied. (Mean age 38.1y, range 2-80y). 23 patients did not reach target and 17(24%) patients underwent adjustment at mean 4.5 days after initial surgery. 6 patients avoided suture adjustment as the deviation improved spontaneously to within the target range.
Discussion: The postoperative deviation spontaneously improved in 6 or 23 patients during first week, and thus suture adjustment was not necessary. The suture knots left under conjunctiva did not need to be tied or removed if the deviation was within the target interval.
Conclusion: Postponed decision on the need for adjustment of short tag noose sutures allows the muscles and tendons to stretch and demask the longterm effect and change in ocular deviation. This may thus decrease the need for suture adjustment.
References: Robbins SL, Granet DB, Burns C, et al Delayed adjustable sutures: a multicentred clinical review British Journal of Ophthalmology 2010;94:1169-1173.