1. Timing of adjusting the sutures

2. Immediate
Early
Late
6-8 hours
24 hours

3. 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, /- 5.8 prism diopter
Group 2, /-11prism diopter
(P=0.5)
Patient selection, no details description

4. 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

5. 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

6. 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)

7. 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:
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

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

9. 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

10. 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)

11. Critque
No control group

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