The adjustable globe: A technique for adjustable strabismus surgery

Background: Conventional adjustable strabismus surgery involves postoperative repositioning of individual muscles anchored to the sclera via adjustable sutures. Greaves has described anchoring opposing rectus muscles to one another, via sutures passing on either side of the limbus. With the muscles disinserted, the 'freed' globe can be adjusted to the desired position within the resulting suture cradle. Friction of the sutures against the sclera holds the muscles in place until healing occurs. Methods: Using a cul-de-sac approach, we performed 23 horizontal and three vertical adjustable globe procedures, with median follow-up of 7 weeks. Four procedures were performed on nonhuman primates, monitored with iris fluorescein angiography. Results: Esodeviations were well corrected, but exodeviations were often grossly undercorrected. Prolonged postoperative discomfort and photophobia were experienced. Possible evidence for mild anterior segment ischemia was noted. Conclusion: Concern about poor results with exodeviations, discomfort, and possible anterior segment ischemia led us to abandon this procedure.