Adjustable Suture Technique in Pediatric Strabismus with Ketamine Anesthesia

ABSTRACT

Adjustable suture technique may be indicated for strabismus surgery when the surgical outcome will be uncertain. We used ketamine intramuscular injection for sedation the day, and performed adjustment after the surgery to enhance the postoperative success rate. The results were analyzed. The average age of the 29 pediatric patients was 53.5 +/-21 months and they were devided into 22 exotropia group and 7 esotropia group. The minimal postoperative observation period was 3 months(average 4.2+/-1.6 months). Among 22 exotropia patients, 13 patients were adjusted and the advancement amount was 1~2 mm. Esotropia was not adjusted. In the final follow-up evaluation, 19 exotropic patients(86.4%)and 7 esotropic patients showed the favorable outcome. However, 3 exotropic patients failed. Two were overcorrected and 1 was undercorrected. In 1 overcorrected case, the postoperative V pattern esotropia occurred. When the alignment can be measured and the picture of external eyes can be obtained, postoprative adjustment was possible after ketamine intramuscular injection. Since the degree of preoperative alignment and the precise evaluation of preadjustment alignment play an important role in determining the advancement amount, careful evaluation should be performed.