Abstract
To compare the surgical results of adjustable and non-adjustable horizontal strabismus surgery for concomitant horizontal strabismus. The charts of 231 patients, who underwent horizontal strabismus surgery, selected using probabilistic sampling, were retrospectively reviewed. Patients were divided into two groups according to the surgical technique used and strabismus type. The adjustable suture technique was used for 107 patients (Group 1), and non-adjustable or conventional surgery was performed in the remaining 124 patients (Group 2). Patients with esotropia (ET) or exotropia (XT) of <55 prism diopters (PD) at distance were included. The following exclusion criteria were applied: all intermittent or vertical deviations, anisotropias >5 PD, syndromes, restrictive or paretic strabismus, reoperations, botulinum toxin injection, and patients postoperatively followed up for <3 months. Surgical success was set to a range between orthotropia and an esodeviation of up to 10 PD for both ET and XT. An amblyopia rate >50% was present in all subgroups. Significant differences between strabismus groups submitted to adjustable technique and non-adjustable on postoperative day 1 were observed (p=0.00 for ET and p=0.01 for XT) and at the last visit for the XT group with a follow-up of at least 1 year (p=0.05). The adjustable suture technique produced a higher success rate than non-adjustable strabismus surgery for both ET and XT groups on postoperative day 1. For XT patients, the adjustable suture technique appears to produce better surgical results than non-adjustable surgery, when the surgical goal is long-lasting maintenance of a small hypercorrection.
Highlights
The objective of strabismus surgery is to achieve motor alignment and sensory improvement with a minimum number of procedures[1]
A historical or retrospective cohort was adopted for the present study to highlight the need of a reliable sample of patients whose selection followed strict inclusion and exclusion criteria[9]
According to Weston et al[10] and Wisnicki et al[11], the success rate among adjustable suture surgeries is lower in patients previously operated on to correct ET and XT
Summary
The objective of strabismus surgery is to achieve motor alignment and sensory improvement with a minimum number of procedures[1]. Tables and algorithms for the number of muscles to be included in the surgery have been formulated based on the results obtained from large patient populations; standardized calculations are affected by various factors that could reduce the success of surgical results[3]. The ability to modify the site of the muscle insertion in the globe and possibility of refining surgical results and controlling postoperative deviations caused Jampolsky to reintroduce an adjustable suture technique in 1975 that was based on the ideas of O’Connor, Harms, and Bielschowsky[4,5,6]. The indications for adjustable sutures are numerous and include several circumstances of an unforeseen nature (paralysis, restrictive strabismus, and history of prior surgery). The adjustable suture technique has been used for over three decades and the applicability of the method has been widely reported, randomized control trials are required[7], and its indication for horizontal concomitant deviations is controversial
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