Comparison of Two Different Extraocular Muscle Suturing Techniques for Strabismus Surgery

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-06-20 DOI:10.1016/j.ajo.2025.06.019

Tiantian Zhou , Wei Guo , Xiaoqi Zhu , Yu Jing , Qing Shao , Shiya Shen , Xin Chen , Zhenhua Leng , Bin Liu , Shihua Zhang , Wanwen Xu , Hu Liu , Hui Zhu

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引用次数: 0

Abstract

Objective

To compare the surgical outcomes after bilateral medial rectus recession (BMR) or bilateral lateral rectus recession (BLR) performed with the 3-point fixation (3PF) vs 2-point fixation (2PF) suturing techniques.

Design

Prospective clinical cohort study.

Subjects

Patients diagnosed with concomitant esotropia or concomitant exotropia and undergoing BMR or BLR with the 3PF or 2PF techniques between January 2022 and January 2025 from the Nanjing Strabismus Cohort Study were included.

Methods

Postoperative deviation angles were recorded at regular follow-up visits. A Cox proportional hazards model was used to estimate the association between suturing techniques and surgical outcomes.

Main outcome measures

The primary outcome was overcorrection, defined as distant eso/exodeviation >10 prism diopters (PD) after BLR or BMR. The secondary outcome was undercorrection/recurrence, defined as distant exo/esodeviation >10 PD after BLR or BMR.

Results

A total of 248 patients were included, with a mean age at surgery of 8.67 ± 6.35 years, of whom 52.42% were male. Of these, 113 underwent surgery with 2PF, and 135 with 3PF. Overcorrection occurred in 27 (10.89%) patients and undercorrection/recurrence occurred in 20 (8.06%) patients. The cumulative incidence of overcorrection was higher in the 2PF group (33.72%; 95% CI, 30.39%-37.22%) compared with the 3PF group (13.09%; 95% CI, 11.71%-14.43%) across the follow-up period (difference: 20.64%, 95% CI, 16.96%-24.28%). Patients in the 3PF group had a 62% decreased risk of overcorrection compared with those in the 2PF group (hazard ratio [HR] = 0.38; 95% CI, 0.16%-0.91%). No significant difference was observed in the cumulative incidence of undercorrection/recurrence between the 2PF group (46.50%; 95% CI, 43.18%-49.96%) and the 3PF group (47.50%; 95% CI, 44.04%-50.99%) over the follow-up period (difference: −1.01%, 95% CI, −5.85% to 3.91%). The suturing technique was not associated with undercorrection/recurrence (HR = 1.07; 95% CI, 0.42%-2.76%).

Conclusions

These findings support that the 3PF suturing technique is a superior alternative to the 2PF technique for reducing overcorrection in bilateral horizontal rectus muscle recession surgery.

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斜视手术两种不同眼外肌缝合技术的比较

比较双侧内侧直肌收缩（BMR）或双侧外侧直肌收缩（BLR）采用三点固定（3PF）与两点固定（2PF）缝合技术后的手术效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.