Does pulling of the suture nullify strabismus surgery?
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I had my second strabismus surgery back in 1992 when I was 19 years old and an event happened that has haunted me ever since. When I had my second surgery my eyes would turn inward. After the surgery everything was perfect. When I went for one of my checkups which was maybe 2 or 3 weeks after my surgery I had a suture in my left eye which was causing my eye to be itchy. One of the doctors was told to take care of it. He was tugging on the suture and I good feel my left eye being moved to the left. In my mind I thought what is he doing? He is just supposed to cut the suture that is in the eye out. After several attempts he called my surgeon. When my surgeon came he said something like don't pull on it its the main suture, and to just cut the piece out. The doctor then did it in one shot. After I finished my checkup my eyed were extremely tired. While being driven home which was about an hour later I good feel my eyes start to drift out. I was angry and almost wanted to cry. My eyes drift to the outside if I don't concentrate. If I dominate with my left eye my eyes are straight and easier to control but my right eye can drift. If I dominate with my right eye or look toward my right then things are difficult as I have trouble keeping my eyes straight as my left eye really drifts outside and also turns a bit upwards. I did not tell my surgeon that this happened after the pulling of the suture or ask him if it had any effect because I knew that they wouldn't want to admit a mistake plus nothing outside of another very tiring surgery could be done to fix it. I think I stopped going for quite a few years. When I decided to go back about 12 years later I decided to tell him what had happened and asked him if this was the cause of my eyes now drifting outward. When I asked he look at another doctor beside him looked at me and said no. So basically my question is did the pulling of the suture nullify my operation and cause the balance in my eyes to be ruined or was this probably going to happen anyway?
Posted Sat, 15 Mar 2014 in Vision and Eye Disorders
Answered by Dr. Dadapeer K 55 minutes later
Brief Answer: Cutting of the sutures is not responsible for this Detailed Answer: Hello Welcome to Health care magic Iam Dr. Dadapeer K, an ophthalmologist and I answer health problems related to eye. I went through the detailed history you have sent. It seems you have underwent first squint surgery at the age of 1 and second at the age of 19 years. Again following surgery you are having drifting of the eye outwards if you are not concentrating. Cutting of the sutures may not be responsible for this as the sutures of the muscles in squint surgery are done by absorbable suture materials and they are not removed and they lie deeper. The conjunctival sutures are the ones which are removed and they are put by using non absorbable suture materials. The only technique which involves the adjustment of sutures in squint surgery is surgery with adjustable sutures. Here also suture adjustment is done by 24 hours and by 2-3 weeks are sutures are absorbed as they are absorbable in nature. As you have mentioned in the history that your eyes drift away if you won't concentrate, this indicates lack of development of fusion leading to drifting of eyes and recurrence of squint. The fusion may not develop in congenital cases of squint as in your case. Hence with the above mentioned reasons I strongly feel pulling of the suture have not caused any problem but your squint has recurred. Hope I have answered your question and your doubts. Hope the information is helpful to you. Thank you
Follow-up: Does pulling of the suture nullify strabismus surgery? 36 minutes later
My surgeon did use the adjustable suture technique when I was 19. Before my second surgery my eyes would turn a bit inward. After the surgery it was the opposite they would drift outward and the left eye a bit upward which didn't exist before. Doctor said he overcorrected For me the reason why I am convinced that the pulling of the suture had an effect on my eyes is because instead of slight lifting and cutting off the piece of suture that was in my eye he pulled on the suture as if trying to pull it out which was several times I could feel my left eye move while he was doing this and ultimately an hour or so later my eyes lost their straight position they had since the surgery. Why did my eyes lose their balance right after this event happened?
Answered by Dr. Dadapeer K 30 minutes later
Brief Answer: If adjustable suture itself is cut it is possible. Detailed Answer: Hello Thank you for the follow up In Adjustable sutures squint surgery the muscle is not cut the origin but it is cut in between and the two cut ends are sutured together and this suture can be adjusted later, however in traditional squint surgery the muscle is cut at the origin and it is sutured back to the sclera. Hence in adjustable squint surgery the muscle may drift either away or towards the desired direction of correction as the muscle is weaker. Hence adjustable squint surgery is done only in cases of second surgeries or in cases with unpredictable post operative results. It is possible that if the doctor has cut the main adjustable suture it may cause squint again.But in these cases the squint will be constant and it will begin immediately and it will not worsen further when you are not concentrating. Hence I can conclude that if you are having changing squint which worsens on lack of concentration or fusion, it is because of recurrence. If you had constant squint without any change in the degree of squint and if followed immediately then it is because of cutting of the suture. Hence mere pulling of the adjustable suture will not cause squint if it is cut then you can have recurrence of squint. Hope I have answered your question. Thank you