Timing of postoperative adjustment in adjustable suture strabismus surgery

Purpose: The use of adjustable sutures in strabismus surgery has increased the rate of surgical success. Little data are available on the optimum timi ng for postoperative adjustment after strabismus surgery. We wanted to comp are 2 common practices of adjustable suture technique after strabismus surg ery. Methods: Two comparable groups of 40 patients each, who had strabismus surgery with adjustable suture technique, were prospectively studied. Grou p A had early adjustment the same day of the surgery about 6 hours after th e operation, and group B had late adjustment the next day about 24 hours af ter the operation. Subjective scoring tables were used to evaluate the pain felt by the patient before, during, and after the adjustment and any diffi culties of the adjustment process. Requirements of postoperative pain medic ations and final alignment 6 weeks after surgery were also compared. Result s: Despite adequate statistical power, no significant differences were foun d between the groups regarding pain before, during, and after adjustment, d ifficulties performing the adjustment, and final alignment after 6 weeks (P >.05). Both adjustment schedules were equally associated with mild to moder ate pain before, during, and aft er the adjustment. In the first 24 hours a fter surgery, no overall difference in the use of pain medications was foun d. Nausea and vomiting in the first 24 postoperative hours were more common in the early adjustment group (P =.02). Conclusion: The surgeon can feel f ree to choose the timing for postoperative adjustment. However, wh en perfo rming an early adjustment, the surgeon should be especially prepared to con trol nausea and vomiting.