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Adjustable versus non-adjustable sutures for strabismus.

Shoaib Hassan1, Anjana Haridas, Venki Sundaram

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This study found insufficient evidence to determine if adjustable or non-adjustable sutures are better for strabismus surgery outcomes. More high-quality research is needed to compare these surgical techniques for ocular alignment.

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Area of Science:

  • Ophthalmology
  • Surgical Innovation
  • Evidence-Based Medicine

Background:

  • Strabismus (squint) is a misalignment of the eyes, treatable with medical or surgical options.
  • Surgical techniques for strabismus include adjustable and non-adjustable sutures for extraocular muscles.
  • Uncertainty exists regarding the superior surgical outcome between adjustable and non-adjustable suture techniques.

Purpose of the Study:

  • To compare the long-term ocular alignment accuracy of adjustable versus non-adjustable sutures in strabismus surgery.
  • To identify specific clinical situations where one suture technique offers greater benefit.

Main Methods:

  • Systematic search of multiple databases (CENTRAL, MEDLINE, Embase, LILACS, ISRCTN, ClinicalTrials.gov, ICTRP) up to June 2017.
  • Inclusion of only randomized controlled trials (RCTs) comparing adjustable and non-adjustable sutures for strabismus surgery.
  • Independent data extraction and certainty of evidence assessment using the GRADE approach.

Main Results:

  • One low-certainty RCT involving 60 children with primary horizontal strabismus was identified.
  • No statistically significant difference in ocular alignment at six months between adjustable and non-adjustable sutures (RR 1.18, 95% CI 0.91 to 1.53).
  • The study reported no intraoperative complications but did not assess patient satisfaction or resource use.

Conclusions:

  • Insufficient evidence exists to conclude which suture technique yields more accurate long-term ocular alignment in strabismus surgery.
  • Further high-quality RCTs are required to compare adjustable and non-adjustable sutures, including outcomes like reoperation rates.
  • Future trials should specify patient subgroups and ensure adequate follow-up for reliable results.