We reviewed several articles related to adjustable sutures in strabismus in adults and children.

There are no randomized clinical trials to compare adjustable sutures to non-adjustable sutures in strabismus surgery.  The Cochrane review on this subject makes this very clear.

Based on available data adjustable sutures are beneficial for difficult cases and re-operations.  There may be benefit in children as well however all the available data suffers from some sort of selection or measurement bias.

Other articles reviewed:

  1. Adjustable suture strabismus surgery in infants and children by Ahmed Awadein, MD, Munish Sharma, MD, Marlet G. Bazemore, MD, Hatem A. Saeed, MD, and David L. Guyton, MD
  2. Improved Ocular Alignment with Adjustable Sutures in Adults Undergoing Strabismus Surgery by Monica S. Zhang, MD, Amy K. Hutchinson, MD, Arlene V. Drack, MD, Julia Cleveland, MSPH, Scott R. Lambert, MD
  3. Strabismus surgery: adjustable sutures-good for all? by A Tripathi, R Haslett and IB Marsh

There are many other articles on this subject that couldn’t be reviewed.  Overall we agree that we need randomized controlled trials. We plan to continue to use adjustable sutures in appropriate cases. There may be an opportunity to expand our use of adjustable sutures in children however there are many difficulties with this process and it still isn’t clear that we would reduce the medical risks for these children.