Objective To assess whether outcomes of strabismus surgery are improved by using the adjustable suture technique and to determine which subgroups of strabismus patients benefit most from the adjustable suture technique. Design A retrospective chart review. Participants Five hundred thirty-five adults who had strabismus surgery between 1989–2010. Methods Success was defined as ≤10 prism diopters (PD) for horizontal deviations and ≤2 PD for vertical deviations. Differences in the proportion of successful strabismus surgery were analyzed using a chi-square test with an alpha of 0.05. Main outcome measures Ocular alignment in primary position at a 7-day to 12-week follow-up examination. Results 491 patients met the inclusion criteria (adjustable suture, n=305; non-adjustable, n=186). The success rates for non-adjustable and adjustable groups were 61.3% and 74.8% respectively (χ2=9.91, p=0.0016). Adjustable suture use was particularly beneficial for patients undergoing a reoperation for childhood strabismus (success rate: non-adjustable, 42.4%; adjustable, 65.7% p=0.0268; n=100). The differences in outcomes were not statistically significant for patients with childhood strabismus undergoing a primary surgery (non-adjustable, 65.0%; adjustable, 81.4% p=0.1354; n=90) or with thyroid orbitopathy (non-adjustable, 76.7%; adjustable, 74.1% p=0.8204; n=57). Conclusions Strabismus surgery using adjustable sutures was associated with improved short-term ocular alignment compared to strabismus surgery without the use of adjustable sutures. Adjustable sutures were most beneficial for patients undergoing reoperations for childhood strabismus.

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