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    Short Tag noose adjustable suture for adjustment after strabismus surgery


    Some pearls

    “I call patients at home a day or two after surgery to see how they are doing,” Dr. Hunter says. “That way, I have a pretty good idea about whether they are going to need an adjustment, or whether they need to come into the office at all.”

    Don’t make the sutures too short. If the pole or noose sutures are much less than 5 millimeters, it can be more difficult to get them to stay tucked under conjunctiva.

    Retrieving the suture for the adjustment is usually straightforward but sometimes it can be the longest part of the procedure. Keeping the pole and the noose ends together when tucking them under conjunctiva makes it easier to retrieve both.

    Check to determine whether the muscle is adhering to the globe. When it is, the pole suture will not slide forward easily and it may require additional anesthesia to allow passage of a hook under the muscle attachment site to separate it from the globe. Dr. Hunter confirms that the muscle is free by observing the forward movement of the noose when he pulls on the pole sutures.

    Over time it can become more difficult to move the sliding noose. “After a few days, the sliding movement is not always as smooth as it would have been an hour after placement – it may jump in 1-2 mm increments,” he noted.

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