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Adjustable suture versus nonadjustable suture surgery for childhood strabismus: A meta-analysis
Chang Liu1, Ruohua Yan2, Jingjing Jiang1
1National Center for Children's Health, MOE Key Laboratory of Major Diseases in Children, Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Survey of Ophthalmology
|March 31, 2025
Summary
Adjustable suture (AS) surgery significantly improves early success rates for pediatric strabismus compared to non-adjustable sutures (NAS). However, reoperation rates showed no significant difference between the two surgical methods.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Surgical Techniques
Background:
- Strabismus is a common condition in pediatric patients requiring surgical intervention.
- Adjustable suture (AS) and non-adjustable suture (NAS) techniques are employed for strabismus correction.
- Comparative data on the efficacy of AS versus NAS in pediatric strabismus is crucial for clinical decision-making.
Purpose of the Study:
- To compare the surgical success rates and reoperation rates between adjustable suture (AS) and non-adjustable suture (NAS) techniques in pediatric strabismus patients.
- To conduct a meta-analysis of existing studies to provide robust evidence on the comparative outcomes of AS and NAS.
- To investigate potential differences in outcomes based on strabismus type (exotropia and esotropia).
Main Methods:
- A comprehensive literature search was performed across major scientific databases (PubMed, Medline, Embase, Web of Science, Cochrane Register of Controlled Trials) up to November 30, 2023.
- Eligible studies comparing AS and NAS in pediatric strabismus patients were included in a meta-analysis.
- Data on success rates and reoperation rates were pooled using fixed or random effects models, quantifying differences with risk differences (RDs) and risk ratios (RRs) with 95% confidence intervals (CIs).
- Subgroup analyses were conducted for exotropia and esotropia.
Main Results:
- Five studies involving 8744 patients were included in the meta-analysis.
- Adjustable suture (AS) surgery demonstrated markedly superior success rates compared to non-adjustable suture (NAS) surgery (RD = 0.17, 95% CI: 0.11-0.24; RR = 1.26, 95% CI: 1.15-1.37).
- No significant difference was found in reoperation rates between AS and NAS groups (RD = -0.04, 95% CI: -0.10-0.02; RR = 0.66, 95% CI: 0.40-1.10).
- Outcomes in exotropia and esotropia subgroups were similar regarding the effect of AS.
Conclusions:
- The adjustable suture (AS) technique significantly enhances early postoperative surgical success rates in pediatric strabismus.
- There is no significant difference in reoperation rates between AS and NAS techniques.
- Further research is warranted to ascertain the long-term success rate advantages of the AS technique.
