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Indian J Ophthalmol. 2019 Feb;67(2):258-262. doi: 10.4103/ijo.IJO_398_18.

Outcome of delayed adjustable strabismus surgery in children using a bow-tie optional adjustable technique.

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The Eye Foundation, 582A DB Road, R.S. Puram, Coimbatore, India.
The Eye Foundation, Coonoor Road, ELK Hill Road Junction, Ooty, India.



The aim of this article is to study the feasibility of a delayed adjustable technique of strabismus surgery in children using an optional adjustable suture technique.


The retrospective study included patients <12 years of age. Recessions were done using an optional adjustable bow-tie technique and resections were done by the conventional technique. Patients were evaluated on the third postoperative day and adjustments done when needed. Statistical analysis was done using Microsoft Excel 2010®.


The study included 11 patients with exotropia and 16 patients with esotropia. The mean age of the patients was 5.2 years (range 1-11 years). The mean preoperative distance deviation was 46.7 ± 10.4 prism diopters (PD) for exotropic patients and 47.1 ± 16.9 PD for esotropic patients. The mean preoperative near deviation was 46.6 ± 11 PD for exotropic patients and 52.4 ± 17.1 PD for esotropia. Two patients with exotropia (18.2%) and four patients with esotropia (25%) were adjusted under intravenous ketamine in the operating room under anesthetist supervision. No difficulty was encountered in advancing/recessing the muscles. The success rate at 1 month was 100% for exotropia and 87.5% for esotropia. The success rate at the final follow-up was 81.8% for patients with exotropia and 68.7% for patients with esotropia.


This delayed optional adjustable strabismus surgery technique provides good short-term results and lower adjustment rates.


Delayed optional adjustable; modified Bow-tie; strabismus surgery in children

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