The immediate postoperative adjustment of sutures in strabismus surgery with comaintenance of anesthesia using propofol and midazolam

Abstract

Purpose: Adjustable suture techniques are used to reduce the reoperation rate in strabismus surgery, but traditionally require that final adjustments be made between 1 to 24 hours after surgery. The purpose of this study was to evaluate a new anesthetic technique that would allow immediate postoperative adjustment of sutures in strabismus surgery, thereby improving patient convenience and comfort. Methods: This was a prospective study of strabismus patients who were judged to be appropriate candidates for adjustable sutures. Comaintenance of anesthesia was accomplished using a stepped-down infusion of propofol with midazolam. Final suture adjustments were performed in the operating room immediately upon completion of strabismus surgery. Patient satisfaction was assessed 24 hours later. Patients were followed for 6 weeks postoperatively. Results: A total of 16 patients were studied, with 8 patients having horizontal muscle surgery, 7 patients with vertical muscle surgery, and 1 patient undergoing both horizontal and vertical muscle surgery. The change in deviation after 6 weeks of follow-up was 8 PD or less horizontally in all patients and 4 PD or less vertically in 87% of patients when compared with the alignment in the operating room. Diplopia, if present, resolved in 85% of patients. One patient (6.7%) required a second surgery. The mean drift at 2 weeks horizontally was 1.87 PD esotropic (range, −6 PD exophoric to 18 PD esotropic) and vertically 0.94 PD (range, −4 PD hypotropic to 4 PD hypertropic). The mean drift at 6 weeks horizontally was −0.27 PD exotropic (range, −8 PD exophoric to 8 PD esotropic) and vertically 0.6 PD (range, −6 PD hypotropic to 10 PD hypertropic). Conclusion: The immediate postoperative adjustment of sutures in strabismus surgery may be accurately performed using this new anesthetic technique. (J AAPOS 2002;6:241-5)