Session: Poster session C

Absorbable Sutures in Inferior Rectus Muscle Recession Surgery

Introduction



Inferior rectus (IR) recession surgery can be associated with a significant risk of overcorrection due to the impact of the lower lid retractors, rapid dissolution of absorbable sutures and tight muscles in thyroid eye disease (TED). Non-absorbable sutures have been used to minimise risk of late overcorrection but suffer from their own disadvantages. This study aims to evaluate the efficacy of absorbable sutures in inferior rectus (IR) recession.



Methods



A retrospective study (December 2020 to January 2023) was conducted at a single tertiary referral centre on patients who underwent IR recession for hypotropia. The data collected included preoperative and postoperative orthoptic measurements, presence of TED, surgeon training level (fellow/consultant) and number of muscles operated on. 



Results 



Of the 20 IR procedures identified, all used absorbable 6/0 vicryl sutures. 4 procedures involved TED patients. Success was defined as ≤5 prism diopters (PD) deviation in primary position, 2-12 weeks post-surgery. 9 (45%) were successful using near measurements and 13 (65%) in the distance. Postoperatively, 14 patients (70%) were orthophoric or undercorrected, whilst 6 (30%) were overcorrected. Average undercorrection was 4.57 PD and 6.46 PD for distance and near respectively; overcorrection was 7.33 PD (distance) and 11.83 PD (near). Overcorrection occurred in 50% of TED patients. Logistic regression showed that TED (p=0.35), surgeon training level (p=0.06) and number of muscles recessed (p=0.26) did not have a significant impact (p>0.05) on the procedure success. 



Conclusion



This study shows comparable success rates to literature values for IR recession. Notably, the majority of the cases in this cohort were undercorrected or orthophoric demonstrating the safety of the use of absorbable sutures in inferior rectus recession.