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Adjustable sutures in children using a modified technique
J Mark Engel1, Sepideh Tara Rousta
1Division of Pediatric Ophthalmology, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Insights
This new adjustable-suture technique for pediatric strabismus surgery offers excellent eye alignment, eliminating the need for further manipulation in children not requiring adjustments.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Adjustable-suture techniques are common in adult strabismus surgery to reduce reoperation rates.
- These techniques are less frequent in pediatric cases due to challenges with conscious child adjustments.
Purpose of the Study:
- To evaluate a novel adjustable-suture technique for pediatric strabismus surgery.
- To determine if the technique can eliminate the need for a second adjustment stage in children.
Main Methods:
- Retrospective study of 61 children (ages 12 months-14 years) with exotropia or esotropia.
- Utilized a modified fornix-based adjustable suture with a buried slipknot and closed conjunctiva.
- Postoperative measurements were taken 4-6 hours after initial surgery to decide on adjustments.
Main Results:
- 88% of patients (54/61) achieved orthophoria within 10 prism diopters (PD) at final follow-up (median 19.4 weeks).
- 91% of adjusted patients (20/22) were within 10 PD of orthophoria.
- The technique proved effective for both adjusted and non-adjusted pediatric strabismus cases.
Conclusions:
- The new adjustable-suture technique provides excellent short-term eye alignment in children.
- This method is well-suited for pediatric strabismus surgery, simplifying the process by avoiding further manipulation for many patients.
Purpose:
Adjustable-suture techniques are commonly used to decrease the reoperation rate in adults undergoing strabismus surgery, but they are infrequently used in children because of the difficulty of performing adjustments on a conscious child. The purpose of this study is to evaluate a new technique for using adjustable sutures in children, which makes the second stage of the procedure unnecessary if no adjustment is needed.
Methods:
This was a retrospective study of children who underwent surgery for exotropia or esotropia. The technique used was a variation of the standard fornix-based adjustable suture with a separate slipknot. The pole sutures were buried within the sclera and tied; then the incision of the conjunctiva was closed to cover the adjustable sutures. The patients were then measured 4 to 6 hours after the initial surgery. The decision of whether to adjust was based on predetermined criteria. Those children not adjusted were discharged with no further manipulation needed because the conjunctiva was already closed. For those children who were adjusted, the adjustment was made with the patient under intravenous propofol sedation or laryngeal mask anesthesia.
Results:
A total of 61 consecutive children ages 12 months to 14 years underwent surgery using this technique. Patients were followed-up after surgery for a minimum of 6 weeks (median 19.4). Fifty-four of the 61 patients (88%) were within 10 prism diopters (PD) of orthophoria on their final postoperative visit. Of the 22 patients who underwent an adjustment, 20 (91%) were within 10 PD of orthophoria at their final postoperative visit. The median follow-up was 19.4 weeks (range 6 to 45.9).
Conclusions:
This new adjustable-suture technique was associated with excellent short-term eye alignment. It is particularly suited for pediatric surgery because it eliminates the necessity of further manipulation of children who do not require adjustment.