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    Short Tag noose adjustable suture for adjustment after strabismus surgery


    The sliding noose is then moved up or down the pole sutures to obtain the exact position. In the case under discussion, a 2-mm inferior rectus recession was performed; the position of the sliding noose was confirmed to be 2 millimeters from the exit site using calipers. Five millimeters of additional pole suture is left beyond the sliding noose to allow for an increase in the recession if an adjustment is needed later. The sutures are tucked under the conjunctiva away from the incision. Because of the small size, the incision often does not need to be closed, he explained.

    At the time of suture adjustment, whether on the day of surgery or during an office visit days later, if the alignment is within the target range, there is no need to manipulate any sutures and the patient is free to go home. If the surgeon wishes to decrease the recession, the muscle can be pulled forward by grasping the pole sutures and then cinching the noose backwards toward the muscle; conversely, if the desire is to increase the recession, the pole sutures are grasped behind the noose and the noose is pulled the other way. The adjustment can be repeated (or deferred) 3 to 7 days after surgery. Dr. Hunter stated that in rare cases he has been able to readjust after 10 days but he does not generally plan for an adjustment any more than 7 days later, and he prefers to complete the delayed adjustment within 3 to 5 days.

    The late adjustment is performed in the office and requires anywhere from 15 to 45 minutes depending on the anxiety level of the patient. “Most of the time is spent settling patients down and making sure the eye is sufficiently anesthetized,” Dr. Hunter said.

    The surgical tray for the procedure includes toothed and smooth forceps, two extra-fine needle holders, a tenotomy hook, and calipers. He uses topical lidocaine, either in drop form or pre-drawn in a syringe topped with a flat (Randolph) cannula.

    For particularly anxious patients he prescribes 1 milligram Ativan to be taken before arrival for the assessment and then administers another milligram after he confirms the decision to adjust following the examination. Some patients may benefit from oxycodone. Patients also take 400 to 800 milligrams of ibuprofen for the anticipated headache following the adjustment.   

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