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    Defending adjustable sutures in strabismus surgery

    While there are no randomized, controlled trials to convince skeptics of the benefits of adjustable sutures in strabismus surgery, most comparative studies show improvements in success rates in the range of 10% to 30%.

    Further reading: Femto laser helps acheive 'napkin' capsulotomy

    Now, it may be easier than ever for strabismus surgeons to adopt adjustable sutures thanks to a "short tag noose" adjustable suture technique that allows for optional suture adjustment, according to David G. Hunter, MD, PhD.

     The adjustment can be delayed for days after the initial strabismus surgery is performed or avoided entirely if the target alignment has been achieved.

    “The delayed adjustment procedure is tolerable and can rescue a patient from what may have been a poor outcome,” said Dr. Hunter, who performs an in-office adjustment—if needed—3 to 7 days postoperatively, giving the eye position some time to settle. Many patients require no adjustment at all, and only a small percentage need the delayed adjustment.

    The procedure

    The short tag noose approach can be performed through a small fornix incision, said Dr. Hunter, ophthalmologist-in-chief at Boston Children’s Hospital and professor and vice chair of ophthalmology at Harvard Medical School.

    Once the muscle has been re-attached to the eye with 6-0 Vicryl or an equivalent, the procedure involves five steps:

    1.     Securing the muscle pole suture ends to each other

    2.     Placing a sliding noose around the pole sutures at the desired position near their exit from sclera

    3.     Securing the noose suture ends to each other

    4.     Trimming the pole and noose sutures to a 5 mm length

    5.     Tucking the sutures under the conjunctiva

    Dr. Hunter explained the approach with a patient undergoing an inferior rectus muscle recession. He makes a 5-mm incision and isolates the inferior rectus muscle on a muscle hook. He passes a Guyton small-incision muscle hook that facilitates maintaining the incision under 5-6 mm, pulling the conjunctiva up and over the ball of the muscle hook.

    Next: 'There is no need to manipulate any sutures and the patient is free to go'

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