Acta Estrabológica

SARNICOLA V, TARTAGLIA B, ADDABBO G, CHISCI C

SUTURAS AJUSTABLES Y FIJAS: ESTUDIO COMPARATIVO DE LOS RESULTADOS DE UNA SERIE DE MÁS DE 1.000 INTERVENCIONES

ADJUSTABLE AND FIXED SUTURES: COMPARISON OF THE RESULTS EXTRACTED FROM A CASUISTRY OF MORE THAN ONE THOUSAND OPERATIONS

INTRODUCTION

Adjustable sutures were introduced in the surgical correction of the strabismus by Jampolsky, about fifteen years ago.

From then on, a great number of surgeons use this technique, expecially in adult strabismus surgery. In fact, the risk of the surgieal impredietability is reduced by this technique because the surgeon can regulate surgical effect the day after, when the patient is awake and cooperates. By this way, Helveston (1978) recommends this technique only for dif Fleult strabismus, I mean those strabismus' forms in which surgical result is very much unforesecable as, distiroideal miopaty, reoperations, some cases of paralitic strabismus.

Kushner (1983), on the countrary, recommends adjiustable sutures whenever the patient is able to cooperate with the surgeon, aside from the type of strabismus.

About our experience, at first we used adjiustable sutures only in patients above twenty years old afflicted with «difficult» strabismus, as recommended by Helveston.

Later, we have amplified use of adjiustable sutures to every type of strabismus in patients above six years old who are able to cooperate with surgeon.

In this work, we report our experience based on 1,120 patients operated between 1984 and the middle of 1995: 542 of them by adjustable sutures and 578 by fixed sutures.

The casuistry shows that better results were reached by adjustable sutures both in «difficult» and «no difficult» strabismus.

CASUISTRY (CASE REPORT)

Between 1984 and the middle of 1995, 1,120 patients were operated; 542 by adjustable sutures and 578 by fixed sutures.

Patients operated by adjustable sutures were from six to 59 years old, while patients operated by fixed sutures were from 4 to 40 years old.

We have thought it's convenient to compare results obtained to underline advantages and disadvantages that two surgical techniques offer.

We have subdivided the different types of strabismus in two subgroups:

No diffilcult strabismus, including in this group no paralytic exotropias, esotropias, hipertropias.

Difficult strabismu,s including in this group every type of paralytic strabismus (palsies and paralyses), retraction syndromes, strabismus consequent to Graves' disease and to operations of retinal deteachment using material to engage.

We have compared results obtained in the immediate post-operating phase with our follow-up that change since six months to five years: we have considered a surgical success those patients that presented, with cover-test, an angle of deviation less than 10 p.d.

We have operated, in the group of «no difficult strabismus», using adjustable sutures, 141 esotropias, 99 exotropias and 47 hipertropias.

We obtained a perfect alignement in every case, about esotropias and exotropias, in the immediate post-operating phase, the success was the same at the subsequent follow-up for 134 esotropias (95.03%) and 91 exotropias (91.9%).

About hipertropias we have obtained a perfect alignement, in the immediate post-operating, in 43 cases (91.48%).

About «no difficult strabismus», the average of the results is of 286/287 in the immediate post-operating phase (99.65% and 268/287 on the subsequent follow-up.

In the group of «difficult strabismus» were 95 re-operations, 35 myopathy consequent to graves' disease, 31 cases of srabismus consequent to operations of retinal deteachment using material to engage, 51 palsies or paralysis and 43 retraction syndromes. The average of the results is of 249/255 (97.64%) in the immediate postoperating phase and of 239/255 (93.72%) at the subsequent follow-up. Therefore we can assert that, using adjustable sutures in both groups, we have a success in 535/542 cases in the immediate post-operating phase (98.70%) and in 507/542 patients at the subsequent follow-up (93.54%)

Using fixed sutures in the treatment of «no dfficult strabismus» we obtained a success in 310/357 cases (86.83%) in the immediate postoperating phase and a success in 289/357 patients (72.54%) at the subsequent follow-up.

About «dfficult strabismus», we used fixed sutures in 60 reoperations, 30 miopathy consequent to graves' disease, 54 palsies or paralisis 30 cases of strabismus consequent to treatment of retinal deatchment using material to engage and 47 retraction syndromes.

In these cases, we obtained a success in 202/221 cases in the immediate post-operating phase (91.49%) and the success kept in the subsequent follow-up in 193/221 cases, as 87.33%.

Therefore, using fixed sutures in both groups, we obtained success in 512/578 cases (88.58%) in the immediate post-operating phase and in 482/578 cases at the subsequent follow-up.

CONCLUSIONS

In this work we show that better results were reached by adjustable sutures both in difficult and no difficult strabismus. In fact, about «no difficult strabismus», results vary from 72.54% using fixed sutures to 93.37% using adjustable sutures; besides, about «difficult strabismus» results vary from 87.33% with fixed sutures to 93.72% with adjustable sutures.

Therefore, in both groups, the average of the results vary from 83.39% with fixed sutures to 93.54% with adjustable sutures.

This average value points to better results obtained using adjustable sutures because the cases of dfficult strabismus are, in our casuistry, much more in operations with adjustable sutures than in operations with fixed sutures, I mean 47.04% in adjustable sutures and 38.23% in fixed sutures.

Besides, in this work the results in the immediate post-operating phase are the same also in the subsequent follow-up in more than 90% of patients as using adjustable that fixed sutures.

In fact, using adjustable sutures, the result was the same in 507/535 patients as 94.76% and using fixed sutures, the result was the same in 482/512 patients as 94.14%: than it's clear the semeiological role of the immediate post-operating phase in the adjustable surgery.

Therefore, using adjustable surgery, we obtain a satisfactory alignement of the eyes with the regulation of the day after and also the possibility to adjuste secondary inconcomitance that sometimes occur using fixed sutures.

Adjustable sutures can be used in every patients over six years old, but it's very important that these patients have the ability to cooperate with surgeon and the surgeon can be convincing with his patients.

Complications of this technique are not different by those of traditional strabismus surgery.