Adjustable versus non-adjustable sutures for the eye muscles in strabismus surgery

Strabismus occurs when the eye deviates from its normally perfect alignment, and can be corrected with surgery. A variety of surgical techniques are available, including the use of adjustable or non-adjustable sutures for the muscles surrounding the eye. There is uncertainty as to which of these suture techniques results in a more accurate alignment of the eye, and whether there are specific situations in which it is of benefit to use a particular technique. This review could not find enough evidence to answer these questions and suggests that more research is needed. The review authors used existing evidence to propose that future randomised controlled trials should directly compare the adjustable to the non-adjustable suture technique, in co-operative patients with any type of strabismus. Trials should have a minimum of six months follow-up and should include important outcome measures such as re-operation rates, accuracy of ocular alignment, complications, economics and patient satisfaction. The information generated from well-designed studies could support a change in the conventional surgical management of strabismus and help to direct planning of surgical training.

Authors' conclusions: 

No reliable conclusions could be reached regarding which technique (adjustable or non-adjustable sutures) produces a more accurate long-term ocular alignment following strabismus surgery or in which specific situations one technique is of greater benefit than the other. High quality RCTs are needed to obtain clinically valid results and to clarify these issues. Such trials should ideally a) recruit participants with any type of strabismus or specify the subgroup of participants to be studied, for example, thyroid, paralytic, non-paralytic, paediatric; b) randomise all consenting participants to have either adjustable or non-adjustable surgery prospectively; c) have at least six months of follow-up data; and d) include re-operation rates as a primary outcome measure.

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Background: 

Strabismus, or squint, can be defined as a deviation from perfect ocular alignment and can be classified in many ways according to its aetiology and presentation. Treatment can be broadly divided into medical and surgical options, with a variety of surgical techniques being available, including the use of adjustable or non-adjustable sutures for the extraocular muscles. There exists an uncertainty as to which of these techniques produces a better surgical outcome, and also an opinion that the adjustable suture technique may be of greater benefit in certain situations.

Objectives: 

To examine whether adjustable or non-adjustable sutures are associated with a more accurate long-term ocular alignment following strabismus surgery and to identify any specific situations in which it would be of benefit to use a particular method.

Search strategy: 

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to January 2013), EMBASE (January 1980 to January 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (http://clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 17 January 2013. We also contacted experts in the field for further information.

Selection criteria: 

We planned to include only randomised controlled trials (RCTs) comparing adjustable to non-adjustable sutures for strabismus surgery.

Data collection and analysis: 

We did not find any studies that met the inclusion criteria for this review.

Main results: 

We did not find any studies that met the inclusion criteria for this review, therefore none were included for analysis. Results of non-randomised studies that compared these techniques are reported.

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