Short Tag Noose Technique for Optional and Late Suture Adjustment in Strabismus Surgery

Abstract

Objective: To present and evaluate a new technique that allows the second-stage suture adjustment in strabis- mus surgery to be skipped or delayed if the immediate postoperative alignment is satisfactory. Methods: The “short tag noose” technique replaces long sutures with short tags that can be left under the con- junctiva after adjustment. Retrospectively, the medical records of all patients treated by a single surgeon with this approach between January 1, 2005, and December 31, 2008, were evaluated for success rate ([]10 prism di- opters [PD] horizontal and []6 PD vertical), reopera- tion rate, and complications. Results: Of 120 procedures reviewed, 27 (22.5%) were performed in children; 97 procedures (80.8%) were per- formed in patients with complex strabismus. Mean fol- low-up was 6 months. The success rate was 81.0% for horizontal strabismus and 70.7% for vertical strabismus at 2 months. The reoperation rate was 10.0% for hori- zontal strabismus and 19.0% for vertical strabismus. The noose slipped in 1 patient (0.8%) and was corrected by readjustment on day 4. Two patients (1.7%) required in- office excision of cysts or granulomas. Conclusions: The short tag noose technique simplifies the logistics of suture adjustment and avoids the need for sedation in children who do not require adjustment. It provides the ability to defer adjustment for days after surgery.