Adjustable Sutures In Squint Surgery

By Admin, March 1, 2013

What is an adjustable suture in strabismus surgery?

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

How is an adjustable procedure different from standard squint surgery?

The adjustable suture operation is performed in two steps. First, a standard squint correction surgery involving weakening or tightening one or more eye muscles is performed. During the surgery, an adjustable or “releasable” suture is placed on one or more of the muscle sutures. Second, usually within 24 hours after surgery, eye alignment is checked. If needed, the muscles can be moved or “adjusted” by sliding the adjustable suture knot. Once the desired alignment is achieved, the stitches are tied and trimmed.

Who can have adjustable suture surgery?

Anyone who can cooperate and tolerate mild discomfort and pain can have an adjustable procedure. Usually adults are good candidates for adjustable surgery.

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

Most adults have the muscles adjusted on the same day or the day after surgery, when they are awake. The adjustment may take place in the recovery room shortly after surgery or in the doctor’s room later the same day or the next day. Topical anesthetic drops are used to numb the eye.

Is suture adjustment painful?

The anesthetic drops help to numb the surface of the eye, but there is still sometimes a pressure sensation when the muscle moves. The patient needs to be able to lay still and keep their eyes in one direction of gaze during the adjustment.

What are some of the benefits of adjustable suture surgery?

The benefit of adjustable suture surgery is the ability to fine-tune the immediate surgical outcome. This will hopefully lead to reduced re-operation rates and improved surgical success. This is especially important in more complicated strabismus surgery such as re-operations, trauma or eye movement disorders such as Graves disease (thyroid eye disease).

What are the disadvantages of adjustable suture surgery?

The attachment site of the muscle can potentially vary with healing since the muscle is not actually sutured directly to the sclera (wall of the eye) as in standard strabismus surgery. Eye muscles can both slip back farther than desired or forward after the adjustment period. Changes in eye alignment, however, can occur during the healing period with both 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 adjustable suture knot also causes relatively more redness and discomfort after surgery and takes longer to dissolve.

Do all Squint surgeons use adjustable sutures?

Not all squint surgeons use adjustable sutures. This is largely due to the personal preference of your eye doctor/ squint surgeon.