Early and delayed suture adjustments after adjustable suture strabismus surgery: a randomized controlled trial

Abstract Background: Adjustable sutures increase the success rate of strabismus surgery. However, the optimal timing of postoperative suture adjustment remains controversial. This trial was aimed at comparing the surgical outcomes and pain scores of early or ۲ – ۴ h and delayed or ۲۴ h postoperative suture adjustment in adult patients undergoing strabismus surgery. Methods: An open-label, prospective, randomized, comparative interventional study was performed in consecutive adult patients scheduled for eye muscle surgery. Patients were randomized into two groups: the early group, with suture adjustment ۲ – ۴ h postoperatively, and the delayed group, with suture adjustment ۲۴ h postoperatively. Subjective pain scores during the adjustment were also analyzed. The angles of misalignment at ۱ and ۳ months and the success rate at ۳ months postoperatively were compared. Results: Forty-five (۹۰%) patients completed the follow-up, including ۲۳ (۹۲%) in the early adjustment group and ۲۲ (۸۸%) in the delayed adjustment group, with a mean (standard deviation) age of ۲۵.۶ (۹.۵) years and a male-to-female ratio of ۴۶.۷:۵۳.۳. Thirty patients (۶۶.۷%) had exotropia, and ۱۵ (۳۳.۳%) patients had esotropia. Both groups had comparable baseline characteristics (all P > ۰.۰۵). The mean pain scores during adjustment did not differ significantly between groups (P > ۰.۰۵). The postoperative angles of alignment were comparable between the groups before suture adjustment and at the ۱- and ۳-month follow-ups (all P > ۰.۰۵). The success rate in the early adjustment group was slightly higher (۸۷.۰% versus ۶۳.۶%), but the difference was not statistically significant (P > ۰.۰۵). The success rate was comparable between the groups in patients with esotropia or exotropia (both P > ۰.۰۵). Conclusions: Although the early adjustment group had a slightly higher success rate, the difference was not significant. Both groups had comparable subjective pain scores during adjustment. Future clinical trials should be performed different time intervals for postoperative suture adjustment, and subjective and objective outcomes, such as diplopia and stereopsis, should be compared between patients with a first strabismus surgery and those who underwent reoperation. This could better resolve the persistent controversy related to the optimal time for suture adjustment.