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Adjustable suture strabismus surgery in pediatric patients using pull-string technique
1Department of Ophthalmology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
Insights
The pull-string adjustable suture technique simplifies strabismus surgery adjustments in pediatric patients, achieving a 75.6% success rate. This method enhances surgeon confidence and patient outcomes in pediatric strabismus correction.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Adjustable suture techniques have been used in strabismus surgery for decades.
- Universal adoption, particularly in pediatric cases, remains limited.
- The pull-string technique aims to simplify postoperative adjustments.
Purpose of the Study:
- To describe the application of the adjustable suture with a pull-string technique in pediatric strabismus surgery.
- To evaluate the efficacy and success rates of this technique in patients aged 18 and under.
Main Methods:
- Retrospective review of medical records for pediatric patients (≤18 years) undergoing adjustable suture strabismus surgery.
- Utilized a specific short tag sliding noose with pull-string technique.
- Patients were categorized into three age groups and followed for up to 6 months post-surgery.
Main Results:
- A total of 123 pediatric patients were analyzed.
- 75.6% of patients achieved orthophoria within 10 prism diopters at final follow-up.
- Success rates were comparable for primary (76.4%) versus reoperative (69.2%) surgeries and for exotropia (77.6%) versus esotropia (71.1%).
Conclusions:
- The pull-string technique demonstrates a comparable success rate to existing methods in pediatric strabismus surgery.
- This technique simplifies postoperative suture adjustments, addressing challenges with buried sutures.
- The pull-string method allows surgeons to confidently perform adjustable suture procedures across all pediatric age groups.
Background/Purpose:
The concept of adjustable suture has been developed in strabismus surgeries for nearly four decades. This technique is not yet universally embraced by strabismus surgeons, especially in pediatric patients. The aim of this study is to describe and evaluate the application of the adjustable suture with pull-string technique in pediatric patients.
Methods:
A retrospective medical record review was conducted for patients aged 18 years and under who received adjustable suture strabismus surgery using short tag sliding noose with pull-string technique. For the analysis, the patients were arbitrarily divided into three age groups: 6 years and younger, between 6 and 12 years, and 12 years and older. Patients were examined at 1 week and 1, 3, and 6 months after surgery.
Results:
A total of 123 patients were enrolled in this study. The mean age at the time of surgery was 9.4 years, ranging from 0.7 to 18.4 years. Eighteen (14.6%) patients required adjustment and 105 (85.4%) patients did not require adjustment. The average follow-up was 10.2 months (range, 1-48 months). At their final postoperative follow-up, 93 of 123 (75.6%) patients were within 10 prism diopters of orthophoria. The success rates were 77.6% (66/85) in exotropia patients and 71.1% (27/38) in esotropia patients. The success rates were 76.4% (84/110) for those who receive the procedure as primary surgery and 69.2% (9/13) for those who receive the procedure as reoperative surgery. Of the 18 patients who required adjustment, 16 (88.9%) patients were successful. Of the 105 patients who did not require adjustment, 77 (73.3%) patients were successful.
Conclusion:
This study showed that the pull-string technique provided similar success rate compared to those reported in literature in pediatric patients. The pull-string technique is developed to simplify the postoperative adjustments. Many surgeons encounter difficulties to handle the postoperative adjustments, especially when they need to retrieve the buried subconjunctival adjustable sutures. The obstacles are reduced with the aid of pull string. Using the pull-string technique, the surgeon can perform adjustable suture surgeries in any age group with confidence.
