THE PARALIMBAL APPROACH WITH DEFERRED CONJUNCTIVAL CLOSURE FOR ADJUSTABLE STRABISMUS SURGERY

Interest in the adjustable suture technique was renewed in the mid-197 0s. The authors report a new modification of the fornix and limbal con junctival approaches that combines the advantages of both. A paralimba l conjunctival incision is placed halfway between the limbus and the m uscle insertion and directed parallel to the muscle insertion. This ap proach permits easy access to the rectus muscle. After the adjustable suture is temporarily secured with a bow-tie knot, the conjunctiva is partially closed using a loop suture over the muscle suture. An option al modification is the use of a ''sweep suture'' to break early adhesi ons at the time of adjustment. The adjustment procedure is performed a t least 6 hours after the surgery. The conjunctiva is retracted as nec essary for access to the muscle suture. If a sweep suture is used, thi s is first withdrawn before attempting any adjustment. After adjustmen t, the conjunctival loop suture is closed, covering the muscle suture. The sweep suture serves as a safeguard for what may otherwise be a di fficult adjustment. This approach increases patient comfort after the surgery.