Innovative single-armed suture technique for Strabismus surgery

Purpose: To describe a novel single-armed suture placement technique during rectus muscle recession in the management of horizontal strabismus. Methods: Forty consecutive patients were included in this retrospective study. Forty-three muscles, 23 medial recti and 17 lateral recti, of 20 patients affected by esotropia or exotropia were sutured with this novel technique, which involved the use of a single armed 6-0 polyglactin 910 (Ethicon Vicryl ®) suture to attach the rectus muscle to sclera. Twenty patients affected as well by esotropia or exotropia were used as control group (22 medial recti and 16 lateral recti). All cases were performed by the same surgeon. Measurements of ocular alignment were taken before and after the operation and the difference, in prism dioptres at cover test for distance (6m) and near (30cm), was reported. Mean and standard deviation of the differences between pre- and post-operative measurements were obtained and studied using the student t-test. A P value of more than 0.05 was considered statistically significant. Results: Mean difference between before and after surgery at cover test for distance was 31.1 ± 20.90 dioptres in the study group and 23.7 ± 13.83 in the control group (P= 0.188644). Difference for near was 31.4 ± 19.25 in the study group and 26.1 ± 13.17 in the control group (P= 0.218981) In two cases it was necessary to include an additional central suture to correct the central sagging of the tendon. In no cases did we observe the dissolution of the suture knots or of slipping back of the muscle. Conclusions: The results obtained with this new suture technique, in terms of correction of the deviation are comparable to those obtained by the same surgeon suturing with the more widely used double-armed technique. The advantages of this technique are its speed and ease of execution. It can be easily taught to trainees and can improve operating times in horizontal and vertical strabismus surgery