title: Utility of adjustable sutures in primary strabismus surgery and reoperations.
abstract: OBJECTIVE
  To evaluate the success of adjustable suture (AS) and nonadjustable suture (NAS) strabismus surgery in primary procedures and reoperations.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Four hundred four patients older than 12 years who underwent strabismus surgery over a 13-year period.
  
  
  METHODS
  All eyes underwent the same hang-back suturing technique by a single surgeon (S.P.K.) in both the AS and NAS groups. Success was defined as alignment within 10 prism diopters (PD) for horizontal recti and within 5 PD of orthophoria for vertical recti without diplopia or further surgery.
  
  
  METHODS
  Surgical success rate of AS and NAS primary surgery or reoperations was the primary outcome measure. Effects of amblyopia, binocularity, and strabismus type on success were secondary outcome measures and were analyzed using multiple logistic regression.
  
  
  RESULTS
  Patients in the AS group required adjustment in 28.8% of cases. Higher overall success was seen with AS (77.7%) compared with NAS (69.1%) surgery, although this did not reach significance (P = 0.059). Overall success for AS in exotropia surgery (80.8%) was significantly higher than that in the NAS group (65.9%; P = 0.011). This was because of higher success in patients undergoing primary surgery (82.5% vs. 50%; P = 0.003), but not in patients undergoing reoperation (80.2% vs. 77.6%; P = 0.71). On multiple regression analysis, male gender and not having a mechanical or neurogenic cause for strabismus were significant factors for a successful outcome. Overall, other factors including amblyopia, binocularity, strabismus type, and primary or reoperation were not significant.
  
  
  CONCLUSIONS
  These results suggest that primary surgery in adults with exotropia has a more successful outcome with AS surgery. This advantage was not present with esotropia and vertical deviations in this series.
authors: Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Canada. kamiar.mireskandari@sickkids.ca
authors: Kamiar
authors: K
authors: Mireskandari
authors: Melissa
authors: M
authors: Cotesta
authors: Jennifer
authors: J
authors: Schofield
authors: Stephen P
authors: SP
authors: Kraft
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013285:Strabismus / Q000601:surgery*; D013536:Suture Techniques; D015348:Vision, Binocular