Utility of Adjustable Sutures in Primary Strabismus Surgery and Reoperations

Mireskandari, Kamiar; Cotesta, Melissa; Schofield, Jennifer; Kraft, Stephen P.

doi:10.1016/j.ophtha.2011.08.025

Cited by 27 publications

(27 citation statements)

References 15 publications

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“…Therefore authors have relied on retrospective studies to demonstrate a benefit for adjustable suture surgery 2 3 10 13 14. The entire premise of using adjustable sutures depends on whether long-term success can be based on achieving the ideal initial ‘target range’.…”

Section: Discussionmentioning

confidence: 99%

“…The entire premise of using adjustable sutures depends on whether long-term success can be based on achieving the ideal initial ‘target range’. Our group argued that a randomised controlled trial in strabismus surgery is long overdue 3. However, for such a study protocol to be feasible, robust evidence is required as to what target range must be achieved postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…This early target range is based on the likelihood of postoperative alignment drift 6–9. Although surgeons performing adjustable suture surgery feel a target range is important, the range used varies and can be modified by fusion potential and underlying diagnosis 2 3 5 10. Liebermann et al 10 found that moving a muscle during an immediate postoperative adjustment does not itself lead to worse long-term postoperative outcomes.…”

mentioning

confidence: 99%

“…Liebermann et al 10 found that moving a muscle during an immediate postoperative adjustment does not itself lead to worse long-term postoperative outcomes. Therefore, an immediate residual or consecutive postoperative misalignment, which the majority of strabismus surgeons feel would likely lead to a poor long-term postoperative outcome, might benefit from the availability of an adjustable suture 2 3 10. However, the direct relationship between achievement of an immediate postoperative angle within a target range and its effect on surgical success has not been conclusively demonstrated in a large patient population.…”

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confidence: 99%

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Achieving postoperative target range increases success of strabismus surgery in adults: a case for adjustable sutures?

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Achieving postoperative target range increases success of strabismus surgery in adults: a case for adjustable sutures?

et al. 2015

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“…In the same sense, the immediate adjustment of the ocular positions cannot be assumed also as an ultimate solution to avoid late undesired results (under or overcorrections of the strabismus). Even when adjustable sutures are used, the incidence of an unsuccessful outcome is sometimes high, not different of surgeries without additional procedures (10)(11)(12) . Variations of convergence by means of, a) the accommodation (in creased convergence by increased accommodation produced by plus minus lenses or by decreasing the value of needed positive ones; or decreased convergence, by the opposite procedures) and/or b) facilitation of binocularly fusional mechanisms (by prisms) are a possible and common methods, but limited by several factors and with a relatively small range of correction.…”

Section: Conventional Modesmentioning

confidence: 99%

A major problem in strabismus and its possible solution

Bicas¹

2014

Arquivos Brasileiros De Oftalmologia

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Purpose: One of the challenges in strabismus is to guarantee stability of the surgical corrections. Re-surgeries are often required even after careful diagnosis, planning, and execution. Several factors contribute to this undesired outcome and the existing management strategies are ineffective. The present alternative is to compensate for their consequences. Ocular rotations are evoked by muscular contractions and relaxations (active forces). During eye movement, periocular tissues are stretched, storing part of the kinetic energy, which may be posteriorly recovered (passive forces), whereas the remaining part of the energy is lost via friction and inelastic deformations (dissipative forces). A method for measuring the forces that cause post-surgery eye drift has not been reported. However, this may be indirectly determined as a function of the respective mechanical variables. The estimated ratio between the kinetic energies of a post-surgery eye drift and a normal pursuit eye movement is ~10 -15 . Theoretically, it can be expected that the addition of continuously acting forces of such magnitudes to the oculomotor system might prevent the undesired post-surgery eye movement. Methods: Several methods for increasing the restraining, dissipative forces to ocular rotations may be conceived. One method is to increase the friction to ocular movements, as for instance, by periocular injection of viscous substances. Another possibility is to use the forces of a magnetic field, which may stabilize the eye in a desired position without avoiding the rotations caused by greater muscular forces acting on it. It has been demonstrated that these forces neutralize the nystagmic movements, whose intensities of mechanical variables are much higher than those of a post-surgery eye drift. Some models of application of this technique are then discussed. Small magnets fixed to the orbit and metallic ferromagnetic elements fixed to the sclera to cover a suitable extension appears to be the best method for providing starting and sliding friction to the oculomotor system. Results: Weak magnetic fields do not cause ocular ill effects. Additionally, the ma g netic field may be confined to the elements of the circuit and may not leak. However, the magnetic materials may interfere with magnetic resonance image (MRI) examinations. requires a detailed clinical examination and the capability to correctly interpret the collected data. Examples of diagnostic errors include unobserved muscular dysfunction and an association between the vertical and horizontal deviations, or the "V" pattern. A second factor is the surgical planning, which require a deep knowledge of the theme and excellent strategic experience necessary to relate the diagnostic findings to the expected surgical outcome. Poor selection of the extraocular muscles to be operated on or procedures to be performed on each muscle leads to undesired outcomes. The third factor is the A major problem in strabismus and its possible solution Um grande problema no estrabismo e suas po...

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