[Value of adjustable sutures in the treatment of diplopia]

Adjustable sutures have been used as a curative procedure in 31 cases of diplopia, 16 cases of plegic causes, 4 cases of acute concomitant squint and 11 cases of mechanical strabismus: thyroid myopathy, orbital fracture, oculomotor imbalance after scleral indentation. In oculomotor paralysis if a few functional motor units remained at plegic muscle level, we were able to obtain new rotational balance by combining, with adjustable sutures, recession and resection of the couple agonist-antagonist. On the other hand, if no functional motor unit remained, it was then necessary to turn to the muscular translocation process modulated by adjustable surgery. In acute concomitant strabismus, adjustable retroposition of the medial rectus enabled us to fall back into an area controlled by fusional vergencies. Lastly, in mechanical strabismus by passive limitation, adjustable sutures usually enabled hyperaction of the contralateral synergists to be controlled and to bind a new rotational balance, compatible with a simple binocular field of vision. The advantage of this technique was to adapt, on adjustment, the motor response to the new innervational background which had disappeared under anaesthesia.