Adjustable versus non-adjustable sutures for strabismus

 

Abstract

Background

Strabismus, or squint, can be defined as a deviation from perfect ocular alignment and can be classified in many ways according to its aetiology and presentation. Treatment can be broadly divided into medical and surgical options, with a variety of surgical techniques being available, including the use of adjustable or non-adjustable sutures for the extraocular muscles. There exists an uncertainty as to which of these techniques produces a better surgical outcome, and also an opinion that the adjustable suture technique may be of greater benefit in certain situations.

Objectives

To examine whether adjustable or non-adjustable sutures are associated with a more accurate long-term ocular alignment following strabismus surgery and to identify any specific situations in which it would be of benefit to use a particular method.

Search methods

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2010, Issue 3), MEDLINE (January 1950 to September 2010), EMBASE (January 1980 to September 2010), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to September 2010), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 27 September 2010. We also contacted experts in the field for further information.

Selection criteria

We planned to include only randomised controlled trials (RCTs) comparing adjustable to non-adjustable sutures for strabismus surgery.

Data collection and analysis

We did not find any studies that met the inclusion criteria for this review.

Main results

We did not find any studies that met the inclusion criteria for this review, therefore none were included for analysis. Results of non-randomised studies that compared these techniques are reported.

Authors' conclusions

No reliable conclusions could be reached regarding which technique (adjustable or non-adjustable sutures) produces a more accurate long-term ocular alignment following strabismus surgery or in which specific situations one technique is of greater benefit than the other. High quality RCTs are needed to obtain clinically valid results and to clarify these issues. Such trials should ideally a) recruit participants with any type of strabismus or specify the subgroup of participants to be studied, for example, thyroid, paralytic, non-paralytic, paediatric; b) randomise all consenting participants to have either adjustable or non-adjustable surgery prospectively; c) have at least six months of follow-up data; and d) include re-operation rates as a primary outcome measure.

 

Plain language summary

Adjustable versus non-adjustable sutures for the eye muscles in strabismus surgery

Strabismus occurs when the eye deviates from its normally perfect alignment, and can be corrected with surgery. A variety of surgical techniques are available, including the use of adjustable or non-adjustable sutures for the muscles surrounding the eye. There is uncertainty as to which of these suture techniques results in a more accurate alignment of the eye, and whether there are specific situations in which it is of benefit to use a particular technique. This review could not find enough evidence to answer these questions and suggests that more research is needed. The review authors used existing evidence to propose that future randomised controlled trials should directly compare the adjustable to the non-adjustable suture technique, in co-operative patients with any type of strabismus. Trials should have a minimum of six months follow-up and should include important outcome measures such as re-operation rates, accuracy of ocular alignment, complications, economics and patient satisfaction. The information generated from well-designed studies could support a change in the conventional surgical management of strabismus and help to direct planning of surgical training.

 

摘要

背景

可調整對照不可調整縫線用於治療斜視

斜視(strabismus或squint)可以被定義為完全對齊的眼睛產生偏差且可以依據病因學與其表現分類。治療大致可以被分類為藥物與手術方法，包括使用可調整或不可調整的縫線用於眼外肌。這些手術技術中何者產生較佳的手術結果存在著不確定，且有意見認為可調整的縫線技術也許在某種狀況下也許具有較佳的利益。

目標

這篇回顧的目的為評估是否可調整或不可調整縫線與斜視手術後長期較精準的眼睛對齊有關。

搜尋策略

我們檢索the Cochrane Central Register of Controlled Trials  CENTRAL in The Cochrane Library (其包含the Cochrane Eyes and Vision Group Trials Register) (2006年第3期)，MEDLINE (1966至2006年9月)，EMBASE (1980至2006年9月)，LILACS (Latin American and Caribbean Literature on Health Sciences) (2006年9月)。我們聯絡該領域的專家以了解進一步的資訊。電子檢索的條件不限制語言。

選擇標準

我們計畫只包括比較斜視手術中使用可調整與不可調整縫線的隨機對照試驗。

資料收集與分析

我們沒有發現任何研究符合這篇回顧的納入標準。

主要結論

我們沒有發現任何研究符合這篇回顧的納入標準，因此沒有進行分析。報告非隨機研究中這些技術的比較結果。

作者結論

沒有可靠的結論關於何種技術(可調整或不可調整的縫線)在斜視手術後眼睛可以長期較精準的對齊，或在何種特定狀況下某種技術比另一種技術的效果佳。需要高品質的隨機對照試驗以獲得臨床上有效的結果並澄清這些問題。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

斜視手術中眼睛肌肉使用可調整對照不可調整的縫線。當眼睛正常完整的對齊產生偏差時會造成斜視，可以用手術矯正之。現有各種的手術技術，包括使用可調整或不可調整縫線用於眼睛周圍的肌肉。這些縫線技術中何種造成眼睛較精準的對齊具有不確定性，且是否有特定的情況下它是有利於特定的技術。這篇回顧無法發現足夠的證據以回答這些問題並認為需要更多的研究。