Adjustable suture versus nonadjustable suture surgery for childhood strabismus: A meta-analysis

We compare the success rate and reoperation rate between adjustable suture (AS) and non-adjustable suture (NAS) in the treatment of strabismus in pediatric patients. We conducted a comprehensive search of scientific databases, including Pubmed, Medline, Embase, Web of Science, and the Cochrane Register of Controlled Trials prior to November 30, 2023., aiming to identify eligible studies for meta-analysis that compared AS versus NAS in patients with strabismus. The differences observed between AS and NAS were quantified as risk differences (RDs) and risk ratios (RRs) along with 95 % confidence intervals (CIs). The data on success rates and reoperation rates were pooled using fixed or random effects model according to the degree of heterogeneity between studies. Subgroup analyses were further performed in patients with exotropia and esotropia. Five studies with 8744 patients were included in this meta-analysis. The success rates observed in the AS group were markedly superior to those in the NAS group, with a RD of 0.17 (95 % CI, 0.11-0.24; P < 0.001) and a RR of 1.26 (95 % CI, 1.15-1.37; P < 0.001); however, there was no significant difference in the reoperation rates between the AS and NAS groups, with a RD of -0.04 (95 % CI, -0.10-0.02; P = 0.19) and a RR of 0.66 (95 % CI, 0.40-1.10; P = 0.11). In the subgroups of exotropia and esotropia, the effect of AS on prognosis was similar. We found that the AS technique can significantly improve the success rate of surgery in the early postoperative period. More evidence-based evidence is needed in the future to confirm whether there is an advantage in the long-term success rate of AS technique.