Nonabsorbable versus absorbable sutures in large, hang-back medial rectus muscle recessions

PURPOSE To investigate the value of nonabsorbable sutures in reducing the incidence of consecutive exotropia after large, "hang-back" medial rectos recessions. METHODS The medical records of patients who underwent medial rectus recession of >= 6.5 mm in individuals <= 2 years of age, or >= 7.0 mm in those >2 years were retrospectively reviewed. Patients were divided-into two groups based on suture material used: absorbable, polyglactin 910 sutures (44 patients); nonabsorbable, polyester sutures (50 patients). Preoperative measurements, ductionsi strabismus surgery, and: postoperative results were analyzed. Inadequate anchoring of the medial rectus muscle was suspected when consecutive exotropia developed 4-7 weeks after surgery after initial satisfactory alignment and was confirmed if during reoperation the medial-rectus muscle appeared recessed >2 mm beyond the originally intended recession. RESULTS Consecutive exotropia due to inadequate anchoring of the medial rectus muscle occurred in 11 of 66 muscles (17%) in the-absorbable suture group. The muscle was found 6-10 mm posterior to, the intended recession., Limited duction in the; field of action of the involved medial rectus muscle occurred in 9 of the 11 muscles (82%). None of the eyes with nonabsorbable sutures showed inadequate anchoring. The incidence of consecutive exotropia was higher in the absorbable suture group (30%) than in the nonabsorbable suture group (6%) (P < 0.005). CONCLUSIONS Using nonabsorbable suture for large, hang-back medial rectus recessions greatly reduces the incidence of consecutive exotropia that can occur when: absorbable suture dissolves.