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    Short Tag noose adjustable suture for adjustment after strabismus surgery


    After completing the adjustment, he steadies the eye with forceps and then asks the patient to look in the direction of the muscle, which pulls it into position.

    After the adjustment, the alignment is checked. If required, the process can be repeated; usually the second or third adjustment in a session is easier to perform because the patient knows what to expect.

    Once the desired alignment is achieved, the adjustment is concluded by tucking the sutures back under the conjunctiva. It takes about 2 months for the sutures to disappear, and more like 4-6 months for the last vestiges of redness to fade.

    The disadvantages of the procedure are the longer operating time (by about 5 minutes), increased suture material after the procedure, increased patient anxiety about the impending adjustment, a chance of changes in alignment despite the suture adjustment, and a risk of oculocardiac reflex during adjustment. “As I have performed more suture adjustments I have learned that if I move slowly, talk to the patient, and pause immediately if a patient describes feeling warm or queasy, I can avoid a vagal reaction,” Hunter said. The biggest disadvantage is the logistics of scheduling the suture adjustment, but the short tag noose gives a lot more flexibility in scheduling than traditional adjustable sutures.

    “The procedure is not necessarily pleasant for patients but it is certainly tolerable, and the concept of suture adjustment makes sense even to patients who are anxious about the procedure. While I don’t need to adjust every patient, or even half the patients, having the ability to perform a suture adjustment – only when needed, and days after surgery in some cases – has transformed the way I approach every case,” Dr. Hunter summarized.


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