THE ADJUSTABLE GLOBE - A TECHNIQUE FOR ADJUSTABLE STRABISMUS SURGERY

Background: Conventional adjustable strabismus surgery involves postop erative repositioning of individual muscles anchored to the sclera via adjustable sutures. Greaves has described anchoring opposing rectus m uscles to one another, via sutures passing on either side of the limbu s. With the muscles disinserted, the ''freed'' globe can be adjusted t o the desired position within the resulting suture cradle. Friction of the sutures against the sclera holds the muscles in place until heali ng occurs. Methods: Using a cul-de-sac approach, we performed 23 horiz ontal and three vertical adjustable globe procedures, with median foll ow-up of 7 weeks. Four procedures were performed on nonhuman primates, monitored with iris fluorescein angiography. Results: Esodeviations w ere well corrected, but exodeviations were often grossly undercorrecte d. Prolonged postoperative discomfort and photophobia were experienced . Possible evidence for mild anterior segment ischemia was noted. Conc lusion: Concern about poor results with exodeviations, discomfort, and possible anterior segment ischemia led us to abandon this procedure.