Adjustment versus no adjustment when using adjustable sutures in strabismus surgery

Purpose: To compare long-term postoperative outcomes when performing an adjustment to achieve a desired immediate postoperative alignment versus simply tying off at the desired immediate postoperative alignment, when using adjustable sutures for strabismus surgery. Methods: We retrospectively identified 89 consecutive patients who underwent a reoperation for horizontal strabismus with the use of adjustable sutures and also had a 6-week and 1-year outcome examination. In each case, the intent of the surgeon was to tie off and only to adjust if the patient was not within the intended immediate postoperative range. Postoperative success was predefined on the basis of the angle of misalignment and diplopia at distance and near. Results: Of the 89 patients, 53 (60%) were adjusted and 36 (40%) were tied off. Success rates were similar between patients who were simply tied off immediately after surgery and those who were adjusted. At 6 weeks, the success rate was 64% for the nonadjusted group versus 81% for the adjusted group (P = 0.09; difference of 17%; 95% CI, -2% to 36%). At 1 year, the success rate was 67% for the nonadjusted group versus 77% for the adjusted group (P = 0.3; difference of 11%; 95% CI, -8% to 30%). Conclusions: Performing an adjustment to obtain a desired immediate postoperative alignment did not yield inferior long-term outcomes compared with tying off to obtain that initial alignment. If patients who were outside the desired immediate postoperative range had not been adjusted, it is possible that their long-term outcomes would have been worse. Therefore, overall, an adjustable approach may be superior to a nonadjustable approach.