A report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel.
Gena Heidary, MD, PhD,1
Vinay K. Aakalu, MD, MPH,2
Gil Binenbaum, MD, MSCE,3
Melinda Y. Chang, MD,4
David G. Morrison, MD,5
Deborah K. VanderVeen, MD,1
Scott R. Lambert, MD,6
Rupal H. Trivedi, MD, MSCR,7
Jennifer A. Galvin, MD,8
Stacy L. Pineles, MD9
Ophthalmology, In Press ©2021 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Purpose: To review the scientific literature that evaluates the effectiveness of adjustable sutures in the management of strabismus for adult and pediatric patients.
Methods: Literature searches were performed in the PubMed database through April 2021 with no date limitations and were restricted to publications in English. The searches identified 551 relevant citations, of which 55 were reviewed in full text. Of these, 17 articles met the inclusion criteria and were assigned a level of evidence rating by the panel methodologist. The search included all randomized controlled studies regardless of study size and cohort studies of 100 or more patients comparing the adjustable versus nonadjustable suture technique, with a focus on motor alignment outcomes or reoperation rates.
Results: The literature search yielded no level I studies. Of the 17 articles that met the inclusion criteria, 11 were rated level II and 6 were rated level III. Among the 12 studies that focused on motor alignment outcomes, 4small randomized clinical trials (RCTs) did not find a statistically significant difference between groups, although they were powered to detect only very large differences. Seven of 8 nonrandomized studies found a statistically significant difference in motor alignment success in favor of the adjustable suture technique, both overall and in certain subgroups of patients. Successful motor alignment was seen in both exotropia (in 3 studies that were not limited to children) and esotropia (in 1 study of adults and 2 of children). The majority of included studies that reported on reoperation rates found the rates to be lower in patients who underwent strabismus surgery with adjustable sutures, but this finding was not uniformly demonstrated.
Conclusions: Although there are no level I studies evaluating the effectiveness of adjustable sutures for strabismus surgery, the majority of nonrandomized studies that met the inclusion criteria for this assessment reported an advantage of the adjustable suture technique over the nonadjustable technique with respect to motor alignment outcomes. This finding was not uniformly demonstrated among all studies reviewed and warrants further investigation in the development and analysis of adjustable suture techniques.
1Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
2Illinois Eye and Ear Infirmary, University of Illinois College of Medicine at Chicago, Chicago, Illinois
3Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
4Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
5Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
6Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
7Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina
8Eye Physicians and Surgeons PC, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
9Jules Stein Eye Institute, Los Angeles, California