Adjustable-suture strabismus surgery: a review of 255 consecutive cases

Adjustable-suture strabismus surgery was performed on 255 patients under general anesthesia. Prophylactic topical and oral antibiotic therapy was used in all cases; only one postoperative infection occurred. Adjustments were needed for 123 patients and were done under topical tetracaine anesthesia within a few hours after recovery from general anesthesia. Overall the adjustments appeared to be reliable. The use of droperidol, however, made reliable adjustment impossible in two cases and is therefore strongly contraindicated if suture adjustment is to be done within a few hours of general anesthesia. There were two cases of temporary palsy of the muscle with the adjustable suture, presumed to be due to the topical anesthetic. Unexpectedly large effects of the surgery occurred in three cases of acquired sixth cranial nerve palsy in which full abduction had been recovered but a concomitant esotropia remained and in a few cases in which the muscles had previously been resected and there were normal active ductions preoperatively. Contraindications to the use of adjustable sutures in strabismus surgery may include multiple orbital fractures, previous orbital floor decompression for dysthyroid ophthalmopathy, and a variable angle.