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| |  Slipknot Adjustable Suture Technique With Short Permanent Tie Achieves Comparable Outcomes in Ocular Alignment: Presented at COS By Louise Gagnon TORONTO -- June 29, 2009 -- Use of a modified suture technique in strabismus surgery is beneficial for patients because it poses less discomfort and achieves comparable outcomes in ocular alignment, according to a study presented here at the 72nd Annual Meeting and Exhibition of the Canadian Ophthalmological Society (COS). The technique uses a slipknot adjustable suture with a short permanent tie, explained Andrew Budning, MD, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, on June 23. Ophthalmologists tie a standard slipknot around the suture when performing the surgery. The muscle, which is typically recessed, is recessed to an appropriate position in hang-back fashion. Surgeons then clamp a suture of about 3 to 4 mm with a needle driver, anterior to the slipknot, and then tie it permanently. This modification permits up to 3 mm of additional recession or advancement of the recessed muscle as far as the level of initial insertion. The short-end suture is then placed under the conjunctiva, and the conjunctiva is closed in a normal manner. This study looked at outcomes with 304 cases and found an 85% success rate with horizontal strabismus and a 90% success rate with vertical strabismus. Patients were aged 5 to 84 years. “With the conventional technique, you have to adjust patients the same day of surgery or, at the latest, the morning after surgery,” said Dr. Budning. “With this technique, we have to do many fewer adjustments. With this technique, you treat patients as you need to treat them. You don’t need to perform adjustment in 100% of cases. It is a technique that can be used in adult and paediatric cases to correct strabismus.” The disadvantage of the conventional approach is that an adjustment is often uncomfortable for patients, so the modified approach means many fewer patients have to endure the discomfort of an adjustment, he added. “We can perform the adjustment several days afterward, if needed,” said Dr. Budning, noting that the adjustment can be carried out for up to 1 week after surgery. “Anyone undergoing strabismus surgery can undergo this technique.” Dr. Budning identified the shortcomings of the novel technique to be muscle adhesion to the globe and the beginning of disruption of the absorbable suture that is used. [Presentation title: The Advantages of the Short Adjustable Suture for Both Adult and Pediatric Strabismus. Abstract P21]
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