A. Adjustable resections tend to be more stressful for the patient.
B. Some say under recess - it is easier to let a muscle slip back than pull it forward - but it can be done if necessary. Others prefer over recession with pull up.
C. Suture breakage can occur - use at least 6-0 suture.
D. Cutting the wrong end of the suture can result in a slipped muscle. Be careful!
E. Patient noncooperation - fainting, etc. - this can be very unpleasant. Use topical anesthesia.
F. Late slippage can occur especially with the inferior rectus.
I saw a patient who had an attempt at adjustable resection of the superior rectus for iatrogenic Brown's from a S.O. tuck - two no-no's. At reoperation the S.R. was recessed 5-7 mm behind its insertion in a mass of scar tissue! The surgeon had "blind" reliance on the adjustable suture.
In strabismus teaching sessions, ophthalmologists universally are eager to hear about adjustable sutures possibly in the belief that even the occasional strabismus surgeon can get it right every time by simply making the correct adjustment. NOT SO!! In addition, the most common strabismus surgeries - congenital ET, intermittent XT, superior oblique palsy, and inferior oblique weakening are not suited well to adjustable sutures.
The Strabismus Minute, Vol.1, No. 24 Copyright (C) 1999 Eugene M. Helveston All Rights Reserved
Editor-in-Chief: Eugene M. Helveston, M.D.
Associate Editor: Faruk H. Orge, M.D.
Editorial Board: Bradley C. Black, M.D.
Edward R. O'Malley, M.D.
David A. Plager, M.D.
Derek T. Sprunger, M.D.
Daniel E. Neely, M.D.
Naval Sondhi, M.D.
Senior Editorial Consultant: Gunter K. von Noorden, M.D.
Graphics: Michelle L. Harmon
Technical Support: George J. Sheplock, M.D.