title: Nonabsorbable versus absorbable sutures in large, hang-back medial rectus muscle recessions.
abstract: To investigate the value of nonabsorbable sutures in reducing the incidence of consecutive exotropia after large, "hang-back" medial rectus recessions.
  
  
  
  The medical records of patients who underwent medial rectus recession of ≥6.5 mm in individuals ≤2 years of age, or ≥7.0 mm in those >2 years were retrospectively reviewed. Patients were divided into two groups based on suture material used: absorbable, polyglactin 910 sutures (44 patients); nonabsorbable, polyester sutures (50 patients). Preoperative measurements, ductions, strabismus surgery, and postoperative results were analyzed. Inadequate anchoring of the medial rectus muscle was suspected when consecutive exotropia developed 4-7 weeks after surgery after initial satisfactory alignment and was confirmed if during reoperation the medial rectus muscle appeared recessed >2 mm beyond the originally intended recession.
  
  
  
  Consecutive exotropia due to inadequate anchoring of the medial rectus muscle occurred in 11 of 66 muscles (17%) in the absorbable suture group. The muscle was found 6-10 mm posterior to the intended recession. Limited duction in the field of action of the involved medial rectus muscle occurred in 9 of the 11 muscles (82%). None of the eyes with nonabsorbable sutures showed inadequate anchoring. The incidence of consecutive exotropia was higher in the absorbable suture group (30%) than in the nonabsorbable suture group (6%) (P < 0.005).
  
  
  
  Using nonabsorbable suture for large, hang-back medial rectus recessions greatly reduces the incidence of consecutive exotropia that can occur when absorbable suture dissolves.
authors.affiliation: The Zanvyl Krieger Children's Eye Center at the Wilmer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Awadein
authors.affiliation: The Zanvyl Krieger Children's Eye Center at the Wilmer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: jdmarsh@cmh.edu.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Marsh
authors.affiliation: The Zanvyl Krieger Children's Eye Center at the Wilmer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: David L
authors.initials: DL
authors.lastname: Guyton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005099:Exotropia / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D011091:Polyesters; D011098:Polyglactin 910; D012189:Retrospective Studies; D013536:Suture Techniques; D013537:Sutures; D015348:Vision, Binocular / Q000502:physiology
chemical_list: D011091:Polyesters; D011098:Polyglactin 910