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Steve Madill; A variation on Optional Adjustable strabismus surgery: applying the Engel/Rousta technique to limbal incisions. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2927.
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© ARVO (1962-2015); The Authors (2016-present)
Adjustable suture strabismus surgery allows correction of immediate post-operative over- and under-corrections. However if no adjustment is indicated then the patient still requires a second intervention to complete the surgical procedure. Engel and Rousta described a fornix-based adjustable suture technique with which, if no adjustment is required, then no second intervention is necessary(1). We describe our experience with the Engel/Rousta technique but applied to limbal incision surgery.
We previously performed adjustable strabismus surgery in adults with a conventional cinch knot technique (figure 1) but due to peri-operative discomfort and the necessity for a second intervention in all patients, we modified our technique to the Engel/Rousta applied to limbal incisions (figure 2).22 adult patients underwent horizontal rectus muscle resect/recess procedures with the Engel/Rousta technique applied to limbal incisions over a 14 month period and had pre- and post-operative orthoptic assessments. Successful alignment was defined as within 10 prism dioptres of target alignment at the 4-6 week review.
Of the 22 patients, median age 37.5 years, 12 had exo deviations (mean deviation 51 prism dioptres for distance) and 10 had eso deviations (mean deviation 39 prism dioptres for distance). Adjustment was required in 5 patients, the other 17 required no further intervention during day admission. At 4-6 weeks, 16/22 patients (73%) were within 10 prism dioptres of target alignment. All 22 patients were satisfied with their final alignment and discharged. We noted anecdotally less conjunctival injection at 4-6 weeks than with our previous technique, but this was not formally graded.
Applying the Engel/Rousta technique to limbal incisions results in satisfactory alignment at the 4-6 week review. If no adjustment is required then this technique also avoids a second intervention to complete the procedure thereby saving surgical hands-on time.1. Engel JM and Rousta ST. Adjustable sutures in children using a modified technique. J AAPOS 2004; 8: 243-248
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Figure 1. Conventional cinch knot technique with loose suture ends
Figure 2. Engel/Rousta technique applied to limbal incisions. Superior and inferior scleral bites allow the muscle suture to be tied off in theatre but if adjustment is required then the knot can be cut out and the suture liberated from the scleral bites
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