Strabismus surgery: adjustable sutures-good for all?

Abstract

Aims: The role of adjustable sutures in strabismus surgery has mainly been limited to conditions like dysthyroid restrictive myopathy, blow-out fractures of orbit, aberrant regeneration of nerves, and certain other long-standing and complicated squints. In this clinical study, an attempt has been made to analyse the efficacy of adjustable sutures in squint surgery as a routine procedure. We also studied patients' acceptability and satisfaction following this procedure and analysed various factors that may influence the surgical outcome (age, sex, previous surgeries, injections of botulinum toxin, etc).

Methods: A total number of 443 patients, aged between 13 and 78 years, who underwent strabismus surgery in our department, from January 1996 to January 2000, were included in this study. Of these patients, 141 had surgery with adjustable sutures and 302 patients without adjustable sutures. Surgical results were followed up for a period ranging from 12 to 50 months. The main outcome measure was a need for a reoperation in the two groups. In addition, we also studied patients' satisfaction with regard to final cosmetic appearance or relief of diplopia; percentage change in angle of deviation in two groups, and influence of various factors such as age, sex, previous surgeries, and injection of botulinum toxin on the final surgical outcome. The results were statistically analysed using Levene's test for equality of variances, t-test for equality of means, and statistical significance of the results was analysed by calculating P-values.

Results: In total, 8.51% of the patients in the adjustable group and 27.15% in the nonadjustable group needed a reoperation. Surgical results were found to be significantly better in patients who had adjustable sutures in comparison to those who did not have adjustable sutures (P<0.005). Patients' satisfaction and percentage change in angle of deviation was also much higher in adjustable sutures group. Age, sex, number of previous surgeries, previous injections of botulinum toxin, and type and amount of deviation had no statistically significant influence on the surgical outcome.

Conclusions: Strabismus surgery with adjustable sutures has a statistically significant better, final result than surgery without adjustable sutures. Patients' satisfaction and percentage change in angle of deviation is also much higher in the adjustable sutures group. As age, sex, number of previous surgeries, previous injections of botulinum toxin, and type and amount of deviation do not influence the final outcome, this type of surgery can be performed in virtually all types of patients.