Adult Strabismus Surgery: Do Adjustable Sutures Increase the Success of Surgery? 

Stephen KraftCanada Speaker Adult Strabismus Surgery: Do Adjustable Sutures Increase the Success of Surgery?Studies comparing strabismus surgical cases using adjustable sutures (AS) to non-adjustable procedures (NA) have focused on the rate of re-operations as well as the alignment results. The majority of the articles, encompassing hundreds of patients, show that AS improve success from both the reoperation rate and alignment aspects. However, systematic reviews point out that prospective controlled studies are lacking, and so conclusions cannot be drawn about the effectiveness of AS. This presentation will provide a brief review of the main articles in the literature comparing success rates with AS versus NA cases, as well as the five goals of an eye muscle operation. Following this introduction, the talk will illustrate the technique the author uses for his AS. Finally, the author will present three lines of evidence confirming the improved alignment success of using AS versus NA cases. This evidence derives from his over 40 years of experience and which is published in several articles from his centre. It is hoped that after this presentation, both novice and experienced strabismus surgeons will feel comfortable incorporating AS into their cases. They will also understand that the additional time and effort in using AS will be justified in improving the success rate of their surgery.Pearls and Tips from 43 Years in StrabismologyIn addition to a careful history, a complete strabismus evaluation involves careful measuring of the alignment in the diagnostic gaze positions and noting the eye muscle actions in the cardinal positions of gaze. The prism measurements and the eye movement gradings must be consistent with each other, so that an appropriate differential diagnosis can be developed. A good refraction is also a vital component of the work-up. This presentation comprises a selection of pearls and tips learned and applied over several decades in the author’s strabismus practice. These tips have helped improve diagnostic skills as well as treatment of both basic and advanced strabismus cases. These items will be discussed in 3 categories: diagnostic testing, non-surgical management, and surgical management. Some items are referenced in various sources, while others have not, to the presenter’s knowledge, been published before. At the end of each section, the specific pearl(s) for the audience will be noted as well as the application of that information. It is hoped that these tips will prove useful for novice as well as seasoned strabismus practitioners.