Timing of adjusting the sutures

Immediate Early Late 6-8 hours 24 hours

8hrs vs 24hrs Spierer et al. Adjustment of Sutures 8 Hours vs 24 Hours After Strabismus Surgery. Am J Ophthalmol 2000;129:521–524. 90 patients (37 &53) Horizontal strabismus Primary + reoperation Angle of deviation Pre-op, post-op before, after adjustment and final follow-up exam Follow-up >6month (6 to 20 months) Last follow up Group 1, -1.6 +/- 5.8 prism diopter Group 2, -2.9 +/-11prism diopter (P=0.5) Patient selection, no details description

8hrs vs 24hrs Conclusion Strengths Limitations No different in suture adjustment 8 hrs or 24 hrs after surgery Strengths Same surgeon All measurements performed by the same person Limitations Patient selection “Patients with Graves ophthalmopathy, neurologic disorders, or traumatic strabismus were excluded in order to form more homogenous and similar study group.” retrospective Selection bias, applicability

6 hrs vs 24 hrs Federico et al. Timing of Postoperative Adjustment in Adjustable Suture Strabismus Surgery. J AAPOS 2001;5:178-83 40 patients in each group No differences Pain (before, during or after) difficulties in performing adjustment Final alignment 6 weeks Differences 6 hr group had more nausea and vomiting Conclusion Surgeon can choose the timing for postoperative adjustment

Critique The surgeon for each group was different. Nausea and Vomiting in the 6 hr group because the group is younger (38.3 +/- 21.4) & (53.7+/- 15.6)

Immediate versus 24 hrs Post-op prism and cover measurements Jamal et al. Comparison of the Immediate with the 24-Hour Postoperative Prism and Cover Measurements in Adjustable Muscle Surgery: Is Immediate Postoperative Adjustment Reliable? J AAPOS 2004;8:528-533 Post-op prism and cover measurements 25 patients Measurement significantly differs in 84% 7.2 +/- 4.3 prism diopter Conclusion Later or delayed adjustment may be a better option

Critique No mention of whether same or different person took the measurements on 2 occasions. The experience of the person taking measurement Prospective study

Immediate adjustment outcome Martin et al. The Immediate Postoperative Adjustment of Sutures in Strabismus Surgery With Comaintenance of Anesthesia Using Propofol and Midazolam. J AAPOS 2002;6:241-5 Prospective study 16 patients Adjustment immediately post op using quick recovery anesthetic technique Selection criteria, strabismus + good vision both eyes

2 weeks 6 weeks Horizontal deviation 1.87 PD (-6 PD exophoric to 18PD esotropic) -0.26 PD (-8PD exophoric to 8PD esotropic) Vertical deviation 0.94 PD ( -4PD hypotropic to 4 PD hypertropic) 0.6PD (-6 PD hypotropic to 10PD hypertropic)

Critque No control group

Summary No difference in early and late suture adjustment Conflicting evidence for Immediate suture adjustment