Adjustable Suture Technique

Abstract

The adjustable suture technique allows for changing the muscle position in the immediate postoperative period, while the patient is awake. Therefore, this technique has the theoretical advantage of allowing fine tuning of ocular alignment. Unfortunately, fine tuning must be done within the first 24–48 h after the procedure, when the muscle function has not completely returned and the patient may still have residual effects of anesthesia. Muscle adjustment requires pulling on the muscle and is often uncomfortable for the patient. Another shortcoming of adjustable sutures is the lack of direct scleral fixation and late changes in muscle position. Ludwig and Chow [1] described stretched scar as a cause of late overcorrection after rectus muscle recession (see Sect. 13.6, at the end of this chapter). Alternatively, large recessions (especially on the lateral rectus) can result in an undercorrection, as the muscle will creep forward. For most “normal” rectus muscles, the most you can hang back a muscle on an adjustable suture is 6 mm. A “tight” muscle, however, can retract back for large recessions. Because of these concerns and the success of the fixed suture technique, the authors prefer using a fixed suture with direct scleral fixation. It is important to note that the late Dr. Marshall Parks did not use the adjustable suture technique throughout his great career.