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Adjustable Sutures in Strabismus Surgery

What is an adjustable suture in strabismus surgery?

Adjustable suture surgery is a technique that allows for change in eye muscle position in the immediate postoperative period. It may improve the chance for desired eye alignment.

Fig. 1 The operation is performed in two steps. First, one or more muscles are repositioned using an adjustable suture technique. The muscle is held in place using a "releasable" suture.

The operation is performed in two steps. First, one or more muscles are repositioned using an adjustable suture technique. The muscle is held in place using a "releasable" suture [See figure 1]. Second, after recovery and usually within 24 hours after surgery, eye alignment is checked. If needed, the muscles can be moved or “adjusted”. If no adjustment is needed the stitches are tied and trimmed. Topical anesthetic or numbing drops are used for pain control.

Who can have adjustable suture surgery?

Cooperative adults who can participate for an adjustment, occasionally teenagers and pre-teens. Rarely, young children have adjustments done in the operating room under anesthesia.

Is the patient asleep or under anesthesia during the suture adjustment?

Usually not. Most adults have the muscles adjusted on the same day or the day after surgery. The adjustment may take place in the recovery room shortly after surgery, or in the doctor’s office later the same day or the next day. Topical anesthetic drops are used to numb the eye.

Is suture adjustment painful?

Usually there is a little discomfort during the adjustment. The numbing drops help a lot. Sometimes there is a pressure sensation when the muscle moves.

Is adjustable suture surgery new?

An adjustable suture technique was first described in 1941; popular use became more widespread after 1975.

What are some of the benefits of adjustable suture surgery?

The benefits include the ability to fine-tune surgical outcomes, to reduce the re-operation rate, and to improve success in more complicated surgery such as re-operations, trauma, or eye movement problems related to Graves’ disease (thyroid eye disorders).

What are the disadvantages of adjustable suture surgery?

The attachment site of the muscle can vary with healing – muscles can both slip back farther than desired or “creep” forward after the adjustment period. Changes in eye alignment can occur during the healing period with adjustable and non-adjustable techniques.

What are some possible complications of adjustable suture surgery?

Breakage of the suture or cutting of the knot can occur during an adjustment. If this happens, some patients will need to go back to the operating room to properly secure the muscle.

Sometimes the muscle won’t move forward or backward as desired. This can be due to healing of the muscle to the sclera, especially for late adjustments, restricted or scarred muscles, or muscles that have lost some of their elasticity.

The heart rate can slow down in some people when an eye muscle has tension put on it, and some people feel faint and nauseous. These reactions are usually very short lived and not serious or severe.

Sometimes the measurements are variable right after surgery and it’s difficult to know what the “real” measurement is. Blurred vision and pain can limit the patients ability to cooperate with both the measurements and the adjustment procedure.

Do all strabismus surgeons use adjustable sutures?

No. Some physicians use this on all cooperative patients, some rarely or never.