Adjustable and non-adjustable strabismus surgery: a retrospective case-matched study

Abstract

Adjustable suture strabismus surgery was introduced to improve results in unpredictable strabismus cases. However, its usage is increasing and in some centres is routine. The present authors propose that the routine use of the adjustable suture technique can only be justified if it can be shown to confer an advantage to the patient. In a retrospective analysis of matched data, they compared the results of their adjustable with non-adjustable strabismus surgery. The adjustable suture procedures performed during a 5-year period, on non-thyroid eye disease patients, were matched to non-adjustable cases according to the type and aetiology of strabismus and the magnitude of deviation. Pairs were matched as closely as possible according to age and strabismus surgery history. All cases were incomitant. The surgical results of the two groups were analysed with regard to the pre-operative and post-operative angles of deviation, the post-operative drift, and a successful outcome, pre-defined by carefully selected criteria. Twenty-six cases were analysed in each of the two groups. Mean pre- and post-operative angles of deviation showed no significant difference between the two groups. 'Success' rates were 81% in the adjustable group and 88% in the non-adjustable group. Given that the success rate of the two techniques is similarly high, a much larger study is required to detect a difference in results, with statistical significance. The authors conclude that there is currently insufficient evidence that patients, without thyroid eye disease, benefit from the longer and potentially uncomfortable procedure of adjustable suture strabismus surgery to support its rapidly growing use and that a prospective randomised controlled trial is indicated.

Adjustable suture strabismus surgery

“…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. Both groups concluded that a much larger study will be required to provide sufficient statistical power to detect a significant difference in results.…”

“…[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.…”

Ergebnisse und Patientenzufriedenheit von Schieloperationen mit nachjustierbaren Fäden im Langzeitverlauf

“…Die Nachjustierungsraten in anderen Studien über die nachjustierbare Technik variieren stark und liegen für die Technik als Spezialeingriff bei 38% [16], 43 % [13] und 54% [18]. Die Raten in Studien über die nachjustierbare Technik als Routineeingriff werden mit 10,5 % [20] und 69,5 % [6] angegeben.…”

“…l " Tab. 2 zeigt vergleichend die verfügbaren Studien, welche die nachjustierbare Technik ebenfalls als Spezialeingriff untersucht haben [13][14][15][16][17][18][19]. Allerdings fehlten in vielen Studien Details zur Rate der Nachjustierungen, Voroperationen und Revisionseingriffen.…”