Modified suture adjustments improve the precision of surgical outcomes in acute acquired comitant esotropia

To investigate whether modified postoperative suture adjustments can reduce postoperative deviation in patients with acute acquired comitant esotropia (AACE) who have significant postoperative phoria or tropia within 1 week of surgery.

The medical records of patients with AACE whose deviation was ≥ 10^Δ assessed with the single Maddox rod test (SMRT) in the early postoperative period were analyzed retrospectively. A modified adjustable suture was placed intraoperatively in all patients. Patients who underwent subsequent suture adjustments within 1 week of surgery comprised the adjustment group; the remainder formed the nonadjustment group. SMRT success was defined as elimination of diplopia and deviation ≤10^Δ assessed using that test.

The adjustment group included 21 patients; the nonadjustment group included 20 patients. In the early postoperative period before suture adjustment, there was no statistically significant difference in SMRT success rate between the adjustment and the nonadjustment groups (10% vs 30% [P = 0.130]); the distance deviation assessed with SMRT was greater in the adjustment group (17.76^Δ ± 5.16^Δ) than in the nonadjustment group (13.40^Δ ± 3.05^Δ [P = 0.002]). At the last postoperative follow-up, the SMRT success rate was higher in the adjustment group than in the nonadjustment group (86% vs 45% [P = 0.009]); the distance deviation assessed with SMRT was lower in the adjustment group (6.05^Δ ± 4.79^Δ vs 13.70^Δ ± 7.48^Δ [P < 0.001]).

Postoperative suture adjustments with modified technique within 1 week of surgery can further reduce postoperative deviation and improve the SMRT success rate in patients with AACE whose postoperative deviation is ≥10^Δ assessed with SMRT.