Short tag noose technique for optional and late suture adjustment in strabismus surgery.
OBJECTIVE
To present and evaluate a new technique that allows the second-stage suture adjustment in strabismus surgery to be skipped or delayed if the immediate postoperative alignment is satisfactory.


METHODS
The "short tag noose" technique replaces long sutures with short tags that can be left under the conjunctiva after adjustment. Retrospectively, the medical records of all patients treated by a single surgeon with this approach between January 1, 2005, and December 31, 2008, were evaluated for success rate (< or =10 prism diopters [PD] horizontal and < or =6 PD vertical), reoperation rate, and complications.


RESULTS
Of 120 procedures reviewed, 27 (22.5%) were performed in children; 97 procedures (80.8%) were performed in patients with complex strabismus. Mean follow-up was 6 months. The success rate was 81.0% for horizontal strabismus and 70.7% for vertical strabismus at 2 months. The reoperation rate was 10.0% for horizontal strabismus and 19.0% for vertical strabismus. The noose slipped in 1 patient (0.8%) and was corrected by readjustment on day 4. Two patients (1.7%) required in-office excision of cysts or granulomas.


CONCLUSIONS
The short tag noose technique simplifies the logistics of suture adjustment and avoids the need for sedation in children who do not require adjustment. It provides the ability to defer adjustment for days after surgery.
Nihalani
Bharti R
BR
Children's Hospital Boston, 300 Longwood Ave, Fegan 4, Boston, MA 02115, USA.
Whitman
Mary C
MC
Salgado
Cristian M
CM
Loudon
Sjoukje E
SE
Hunter
David G
DG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013285:Strabismus / Q000503:physiopathology / Q000601:surgery*; D013536:Suture Techniques; D015348:Vision, Binocular / Q000502:physiology; D055815:Young Adult