Publication: Eficacia de la sutura ajustable para la la corrección del estrabismo en niños y adultos
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2018-04-10
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Universidad Complutense de Madrid
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Abstract
El estrabismo es la desalineación de los ejes oculares cuya prevalencia es del 2 al 9% de acuerdo a la población estudiada que puede traer consecuencias como discapacidad visual, así como dificultad en las relaciones personales. La cirugía es uno de los tipos de tratamiento para el estrabismo que busca mejorar la visión binocular, eliminar la diplopía, tortícolis y el impacto sobre su evolución psicosocial. Existen algunas técnicas aplicadas a la cirugía de estrabismo, pero nosotros abordaremos el uso de la sutura ajustable. La Sutura Ajustable fue popularizada por Jampolsky desde el año 1974. Se la creó como una segunda oportunidad para mejorar los resultados insatisfactorios de la cirugía de estrabismo en una solo intervención quirúrgica. Actualmente el uso de la sutura ajustable no está generalizado entre los estrabólogos y de ellos solo un grupo pequeño lo hacen en niños, probablemente por la curva de aprendizaje y la resistencia de los anestesiólogos a poner a los pacientes nuevamente bajo el efecto anestésico. Las indicaciones de la Sutura Ajustable usualmente son para ciertos casos especiales como reoperaciones, manejo de diplopías, estrabismos restrictivos, desviaciones incomitantes, estrabismos traumáticos y estrabismos por parálisis oculomotoras pero hay otro grupo que las utiliza en todas las intervenciones quirúrgicas de estrabismo. Existen posiciones contradictorias respecto al uso de la Sutura Ajustable. Un grupo se encuentra a favor de su uso indicando que disminuyen la tasa de reoperaciones a un 10% y mejora los resultados inmediatos. Otro grupo indica que no se ha encontrado conclusiones definitivas acerca de qué técnica (sutura ajustable o sutura no ajustable) producía una alineación ocular a largo plazo más exacta o en qué circunstancias una de las dos técnicas provee de un mayor beneficio que otra. Por tal motivo tuvimos interés de generar nueva evidencia científica que puede contribuir a apoyar la eficacia de la Sutura Ajustable y su aplicación tanto en niños como adultos...
Strabismus is the misalignment of the ocular axes whose prevalence is 2 to 9% according to the population studied that can bring consequences such as visual impairment as well as difficulty in personal relationships. Surgery is one of the types of treatment for strabismus that seeks to improve binocular vision, eliminate diplopia, torticollis and impact on its psychosocial development. There are some techniques applied to the surgery of strabismus, but we will approach the use of the adjustable suture. The Adjustable Suture was popularized by Jampolsky since 1974. It was created as a second opportunity to improve the unsatisfactory results of strabismus surgery in a single surgical procedure. Currently the use of adjustable suture is not widespread among strabismus surgeons and only a small group of them do it in children, probably because of the learning curve and resistance of anesthesiologists to put patients back under anesthetic effect. The indications for the Adjustable Suture are usually for certain special cases such as reoperations, diplopia management, restrictive strabismus, incoming deviations, traumatic strabismus and oculomotor paralysis strabismus, but there is another group that uses them in all strabismus surgical interventions. There are contradictory positions regarding the use of the Adjustable Suture. One group is in favor of its use indicating that they reduce the rate of reoperations to 10% and improves the immediate results. Another group indicates that no definite conclusions have been reached as to which technique (adjustable suture or non-adjustable suture) produced long-term ocular alignment more exact term or under what circumstances one of the two techniques provides a greater benefit than another. For this reason we were interested in generating new scientific evidence that can contribute to support the effectiveness of Adjustable Suture and its application in both children and adults...
Strabismus is the misalignment of the ocular axes whose prevalence is 2 to 9% according to the population studied that can bring consequences such as visual impairment as well as difficulty in personal relationships. Surgery is one of the types of treatment for strabismus that seeks to improve binocular vision, eliminate diplopia, torticollis and impact on its psychosocial development. There are some techniques applied to the surgery of strabismus, but we will approach the use of the adjustable suture. The Adjustable Suture was popularized by Jampolsky since 1974. It was created as a second opportunity to improve the unsatisfactory results of strabismus surgery in a single surgical procedure. Currently the use of adjustable suture is not widespread among strabismus surgeons and only a small group of them do it in children, probably because of the learning curve and resistance of anesthesiologists to put patients back under anesthetic effect. The indications for the Adjustable Suture are usually for certain special cases such as reoperations, diplopia management, restrictive strabismus, incoming deviations, traumatic strabismus and oculomotor paralysis strabismus, but there is another group that uses them in all strabismus surgical interventions. There are contradictory positions regarding the use of the Adjustable Suture. One group is in favor of its use indicating that they reduce the rate of reoperations to 10% and improves the immediate results. Another group indicates that no definite conclusions have been reached as to which technique (adjustable suture or non-adjustable suture) produced long-term ocular alignment more exact term or under what circumstances one of the two techniques provides a greater benefit than another. For this reason we were interested in generating new scientific evidence that can contribute to support the effectiveness of Adjustable Suture and its application in both children and adults...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Oftalmología y Otorrinolaringología, leída el 06/06/2017