Scar remodeling after strabismus surgery

Purpose: We sought to investigate abnormal scar lengthening after strabismu s surgery. Methods: Patients with overcorrection after strabismus surgery o r undercorrection after extraocular muscle resection underwent exploration of previously operated muscles. Abnormal findings were documented by inspec tion and photography, and repair was undertaken at first with absorbable su tures and later with nonabsorbable sutures. Results: Lengthened scars, cons isting of amorphous connective tissue, were repaired on 198 muscles in 134 procedures by excision of the scar and reattachment of the muscle to sclera ; absorbable sutures were used in 64 procedures, and nonabsorbable sutures were used in 70 procedures. Thirty-one procedures were followed by partial recurrence of the original overcorrection; 7 of these had documented restre tching. The use of nonabsorbable sutures decreased the recurrence of strabi smus from 42% to 6%. Factors that distinguished patients with stretched sca rs from patients with classic slipped muscles included minimal or no limita tion of versions, less separation of the tendons from sclera, and thicker a ppearance of the scar segments. Conclusions: A lengthened or stretched remo deled scar between an operated muscle tendon-and sc[era may contribute to v ariability of outcome after strabismus repair, even years later. Definitive repair requires firm reattachment of tendon to sclera with nonabsorbable s uture support.