Routine use of non-absorbable sutures in bi-medial rectus recession as a measure to reduce the incidence of consecutive exotropia

Abstract

Objective: To evaluate the incidence of consecutive exotropia following bilateral medial rectus muscle recession surgery (BMR) for esotropia using non-absorbable compared with absorbable sutures in children undergoing strabismus surgery.

Methods: A retrospective cohort study of all children with esotropia who underwent BMR by a single surgeon in a tertiary public hospital. As of February 2018, only non-absorbable sutures were used. The primary outcome was the incidence of consecutive exotropia.

Results: A total of 121 children were included in the analysis, 3.66 ± 2.62 years, 53% were male. In 80 children (66%) non-absorbable sutures were used (non-absorbable group) and in 41 children (34%) absorbable sutures were used (absorbable group). Consecutive exotropia (≥ 8 prism dioptres) occurred in ten children (24%) in the absorbable group and in three children (4%) in the non-absorbable group (OR = 8.28, 95% CI = 2.13-32.13; P = 0.002). This difference between groups remained significant after adjustment for potential confounders and follow-up time (HR = 4.98, 95% CI = 1.30-19.05, P = 0.019). Mean follow-up time was 22 and 12 months in the absorbable and non-absorbable groups, respectively (P < 0.001). Two children in the non-absorbable group had pyogenic granuloma that resolved after 3 months of topical steroidal therapy.

Conclusion: Routine use of non-absorbable sutures in BMR surgery for esotropia may be a preferable alternative to absorbable sutures for the prevention of consecutive exotropia.

Fig. 1. Suturing technique using non-absorbable sutures leaving the knot secured and well-buried beneath the muscle belly to avoid possible complications.

A The needle is passed through the sclera angled away from the insertion. B The knot is tied while being covered by muscle tissue. Both needles were intact. C Both needles are passed distally through the muscle belly and the sutures protrude through the muscle. D Both sutures are pulled up and cut just above the muscle tissue. e Sutures retract beneath the muscle belly.

Fig. 2. The two curves demonstrate the probability of consecutive exotropia during follow-up time in each group.

Kaplan–Meier survival curve for the incidence of consecutive exotropia in the absorbable and non-absorbable groups.