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P. Kelty, J.F. Payne, R.H. Trivedi, R.A. Saunders; Adjustable Sutures in Non–Restrictive Adult Strabismus: The Standard of Care . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2471.
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The use of adjustable sutures is believed by some to be the standard of care in adult strabismus surgery. There have been few randomized, controlled studies comparing adjustable to non–adjustable suture techniques in adult strabismus surgery. The purpose of this study was to determine the pattern of usage of adjustable sutures among pediatric ophthalmologists in adult strabismus patients.
An email survey was sent to the 673 North American AAPOS members listed in the 2005 directory. The survey assessed location of fellowship, years in practice, adjustable suture usage over time, and sample scenarios to validate consistency of responses when applied to a clinical setting.
A total of 307/673 (46%) was counted. Overall, 63% of respondents reported they routinely used adjustable sutures during their fellowship training. In each of three clinical situations presented (commitment esotropia, intermittent exotropia, and superior oblique muscle palsy), almost 60% of respondents reported a preference for using fixed over adjustable suture techniques. There was a significant positive relationship between current use of adjustable sutures and experience in fellowship training (p = 0.001). For those surgeons in practice > 25 years, there was a trend toward greater adjustable suture usage over time (p = 0.11).
More surgeons prefer fixed sutures than adjustable sutures in routine adult strabismus. Both are within the standard of care. A well–designed, prospective, randomized, controlled study would be needed to demonstrate the superiority of either technique for routine cases.
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