A Systematic Review on Conjunctival Closure Techniques in Strabismus Surgery: Current Evidence and Clinical Practice.

Area of Science:

• Ophthalmology
• Surgical Innovation
• Evidence-Based Medicine

Background:

• Strabismus (eye misalignment) surgery commonly uses sutures for conjunctival closure.
• Traditional suturing can increase operative time and postoperative discomfort (irritation, inflammation).
• Exploring alternative sutureless techniques is crucial for improving patient outcomes and surgical efficiency.

Purpose of the Study:

• To systematically review and compare traditional suturing with sutureless techniques in strabismus surgery.
• To evaluate the impact on surgical efficiency, patient comfort, and safety.
• To synthesize evidence on efficacy and identify barriers to implementation.

Main Methods:

• Systematic review adhering to PRISMA 2020 guidelines.
• Literature search of studies published between 2010-2025.
• Included 13 studies (7 RCTs, 6 observational) involving 765 eyes, comparing sutured vs. sutureless closure (fibrin glue, minimally invasive).

Main Results:

• Sutureless methods showed improved early outcomes: reduced inflammation, redness, chemosis, and foreign-body sensation (FBS).
• Sutureless techniques, especially fibrin glue, significantly reduced operative time.
• Both methods achieved comparable long-term alignment success and safety profiles.

Conclusions:

• Sutureless closure, particularly with fibrin glue, presents a more efficient and comfortable alternative to traditional suturing in strabismus surgery.
• Comparable efficacy and safety suggest potential benefits for patient experience and surgical workflow.
• Barriers like cost and learning curves necessitate further high-quality, multicenter trials for widespread adoption.