Delayed adjustable sutures suitable for complex strabismus surgery

The choice of using a closed conjunctival delayed approach to adjustable suture surgery may present some significant advantages to more traditional adjustable suture techniques in the treatment of strabismus, according to David B. Granet MD, FACS, FAAP.

Addressing delegates attending the World Society of Paediatric Ophthalmology and Strabismus (WSPOS) paediatric subspecialty day, Dr Granet said that the technique offers a valuable option for the strabismologist, especially in the case of repeat surgeries and complex strabismus.

“Potential advantages including the decreased risk of infection owing to immediate conjunctival closure, decreased interference from pain and oedema on postoperative measurements, and less physician and patient time due to the decreased need for postoperative adjustment,” he said.

Dr Granet explained that the closed conjunctival approach is a refinement of the traditional
adjustable suture technique which allows fine-tuning of surgical outcomes in the immediate
postoperative period.

The adjustment usually takes place three to seven days after surgery, and is performed by removing or stretching conjunctival sutures and positioning the globe with the traction suture to enable exposure of the cinch or bow knot. The knots are then adjusted until the muscle is in its desired position as confirmed by motility testing before the conjunctiva is re-sutured.