Adjustable suture strabismus surgery in pediatric patients using pull-string technique

Abstract

BACKGROUND/PURPOSE:The concept of adjustable suture has been developed in strabismus surgeries for nearly four decades. This technique is not yet universally embraced by strabismus surgeons, especially in pediatric patients. The aim of this study is to describe and evaluate the application of the adjustable suture with pull-string technique in pediatric patients.METHODS:A retrospective medical record review was conducted for patients aged 18 years and under who received adjustable suture strabismus surgery using short tag sliding noose with pull-string technique. For the analysis, the patients were arbitrarily divided into three age groups: 6 years and younger, between 6 and 12 years, and 12 years and older. Patients were examined at 1 week and 1, 3, and 6 months after surgery.RESULTS:A total of 123 patients were enrolled in this study. The mean age at the time of surgery was 9.4 years, ranging from 0.7 to 18.4 years. Eighteen (14.6%) patients required adjustment and 105 (85.4%) patients did not require adjustment. The average follow-up was 10.2 months (range, 1–48 months). At their final postoperative follow-up, 93 of 123 (75.6%) patients were within 10 prism diopters of orthophoria. The success rates were 77.6% (66/85) in exotropia patients and 71.1% (27/38) in esotropia patients. The success rates were 76.4% (84/110) for those who receive the procedure as primary surgery and 69.2% (9/13) for those who receive the procedure as reoperative surgery. Of the 18 patients who required adjustment, 16 (88.9%) patients were successful. Of the 105 patients who did not require adjustment, 77 (73.3%) patients were successful.CONCLUSION:This study showed that the pull-string technique provided similar success rate compared to those reported in literature in pediatric patients. The pull-string technique is developed to simplify the postoperative adjustments. Many surgeons encounter difficulties to handle the postoperative adjustments, especially when they need to retrieve the buried subconjunctival adjustable sutures. The obstacles are reduced with the aid of pull string. Using the pull-string technique, the surgeon can perform adjustable suture surgeries in any age group with confidence.

A Novel Method Ensuring an Immediate Target Angle After Horizontal Strabismus Surgery in Children

“…The definition of success in strabismus surgery varies among different studies. Most studies set their success criteria as 8 to 10 PD deviations from orthophoria at either the 3-month, 6-month or last follow-up (8,9,12,15,(21)(22)(23)(24). Kushner et al (25) found that orthotropia in infants at their 6-month postoperative visits was more related to better visual function outcomes 5 years later.…”

“…However, compared to most adjustments that could be made in the office only by local anesthetics, adjustments in children seem to be more challenging and painful for both the patients and their parents despite some alternatives in anesthetics ( 9 ). To improve the success rate in pediatric strabismus surgery, certain alternative procedures are combined with strabismus surgeries, such as botulinum toxin A injection ( 10 , 11 ) and pull-string adjustments ( 12 ). However, a need for additional procedures cannot be avoided ( 13 ).…”

Modified Target Angle as a Predictor of Success in Strabismus Management after Orbital Fracture

“…The definition of success in strabismus surgery varies depending on the study and the patient group. The most accepted success criterion across horizontal strabismus studies is 8-10 PD misalignment at either the 3-month, 6-month, or final follow-up [19,25,[28][29][30][31][32][33]. In consecutive strabismus after orbital fracture reconstruction surgery, few studies have achieved a consensus on postoperative success criteria.…”

Adjustable Sutures in the Treatment of Strabismus

“…Such protocols have further expanded the availability of adjustable sutures for pediatric patients. [10][11][12][13][14]…”