One-stage vs. two-stage adjustable sutures for the correction of esotropia

The aim of this study was to evaluate the stability and the level of postoperative consciousness, nausea and vomiting, ocular pain, starting oral intake and activity, and cost-effectiveness in patients undergoing medial rectus recession surgery using an adjustable suture technique that was performed by two different methods.

In this prospective study, we evaluated 78 patients undergoing medial rectus recession surgery. Thirty-eight patients were operated by a one-stage technique in which the whole operation was done under topical anesthesia and adjustment was done on the operating table, while 40 patients were operated by a two-stage technique in which the operation was done under general anesthesia and adjustment was done the following day at the patient's bedside. The results were recorded and compared according to the parameters given above. A scoring system was used to assess all these parameters except for stability. The stability of the procedures was evaluated according to the degrees of squint immediately after the adjustment and at least three months thereafter.

There was no significant difference between the procedures with regard to stability and ocular pain. During the early postoperative period, the level of consciousness was better and nausea and vomiting occurred less frequently in the patients operated by the one-stage procedure. Postoperative activity and oral intake returned to normal status more quickly in the one-stage group and the one-stage procedure was cost-effective.

We conclude that although both procedures provide satisfactory and stable results, the one-stage procedure has significant advantages over the two-stage procedure for medial rectus recession surgery in suitable cases.