Releasable adjustable suture technique for children

Purpose: Residual esotropia is a problem for children with esotropia that can follow bilateral medial rectus recession, and the use of adjustable sutures is nearly impossible. The aim of this work is to describe a new suture technique to overcome this problem. Methods: Medial rectus muscle was recessed and secured to the sclera at the predetermined recession position after suspending it 1.50-2.00 mm farther. A second, releasable suture was placed at the original insertion site, passed under the previously tied muscle suture knot, and tied in a strengthened loop knot, advancing the muscle to the new scleral insertion. The looped end was left long enough to be kept in the inferior fornix. The next day, if the child was undercorrected, intranasal midazolam was given and the releasable suture was drawn out, providing additional muscle recession. Patients aged 10 to 94 months (mean 34 months) with angle of deviation 20 to 60 prism diopters (PD; mean 33 PD) and with follow-up I to 12 weeks (mean 4.5 weeks) were studied. Success was defined as alignment within 10 PD. Results: Of 50 children with esotropia, 32 (64\%) were successfully aligned, and 18 (36\%) were undercorrected with residual angle 14 to 25 PD (mean, 18 PD). After release of the suture, 15 children (83\%) were successfully aligned, and 3 children were still undercorrected. The overall success rate was 94\%. Conclusion: Releasable adjustable suture is a new technique that can help strabismologists attempt bilateral medial rectus recession in children, with a second chance for correction during early postoperative period.