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Abstract：
To review the scientific literature that evaluates the effectiveness of adjustable sutures in the management of strabismus for adult and pediatric patients.
Literature searches were performed in the PubMed database through April 2021 with no date limitations and were restricted to publications in English. The searches identified 551 relevant citations, of which 55 were reviewed in full text. Of these, 17 articles met the inclusion criteria and were assigned a level of evidence rating by the panel methodologist. The search included all randomized controlled studies regardless of study size and cohort studies of 100 or more patients comparing the adjustable versus nonadjustable suture technique, with a focus on motor alignment outcomes or reoperation rates.
The literature search yielded no level I studies. Of the 17 articles that met the inclusion criteria, 11 were rated level II and 6 were rated level III. Among the 12 studies that focused on motor alignment outcomes, 4 small randomized clinical trials (RCTs) did not find a statistically significant difference between groups, although they were powered to detect only very large differences. Seven of 8 nonrandomized studies found a statistically significant difference in motor alignment success in favor of the adjustable suture technique, both overall and in certain subgroups of patients. Successful motor alignment was seen in both exotropia (in 3 studies that were not limited to children) and esotropia (in 1 study of adults and 2 of children). The majority of included studies that reported on reoperation rates found the rates to be lower in patients who underwent strabismus surgery with adjustable sutures, but this finding was not uniformly demonstrated.
Although there are no level I studies evaluating the effectiveness of adjustable sutures for strabismus surgery, the majority of nonrandomized studies that met the inclusion criteria for this assessment reported an advantage of the adjustable suture technique over the nonadjustable technique with respect to motor alignment outcomes. This finding was not uniformly demonstrated among all studies reviewed and warrants further investigation in the development and analysis of adjustable suture techniques.
Literature searches were performed in the PubMed database through April 2021 with no date limitations and were restricted to publications in English. The searches identified 551 relevant citations, of which 55 were reviewed in full text. Of these, 17 articles met the inclusion criteria and were assigned a level of evidence rating by the panel methodologist. The search included all randomized controlled studies regardless of study size and cohort studies of 100 or more patients comparing the adjustable versus nonadjustable suture technique, with a focus on motor alignment outcomes or reoperation rates.
The literature search yielded no level I studies. Of the 17 articles that met the inclusion criteria, 11 were rated level II and 6 were rated level III. Among the 12 studies that focused on motor alignment outcomes, 4 small randomized clinical trials (RCTs) did not find a statistically significant difference between groups, although they were powered to detect only very large differences. Seven of 8 nonrandomized studies found a statistically significant difference in motor alignment success in favor of the adjustable suture technique, both overall and in certain subgroups of patients. Successful motor alignment was seen in both exotropia (in 3 studies that were not limited to children) and esotropia (in 1 study of adults and 2 of children). The majority of included studies that reported on reoperation rates found the rates to be lower in patients who underwent strabismus surgery with adjustable sutures, but this finding was not uniformly demonstrated.
Although there are no level I studies evaluating the effectiveness of adjustable sutures for strabismus surgery, the majority of nonrandomized studies that met the inclusion criteria for this assessment reported an advantage of the adjustable suture technique over the nonadjustable technique with respect to motor alignment outcomes. This finding was not uniformly demonstrated among all studies reviewed and warrants further investigation in the development and analysis of adjustable suture techniques.
摘要：
回顾评估可调节缝线在成人和儿童患者斜视治疗中的有效性的科学文献。到2021年4月，文献检索在PubMed数据库中进行，没有日期限制，仅限于英文出版物。搜索确定了551条相关引用，其中55项进行了全文审查。其中,17篇文章符合纳入标准，并由小组方法学专家分配了证据等级。搜索包括所有随机对照研究，无论研究规模如何，以及100名或更多患者的队列研究，比较可调整和不可调整缝合技术。重点关注运动调整结果或再手术率。
文献检索没有产生I级研究。在符合纳入标准的17条条款中，11个被评为II级，6个被评为III级。在专注于运动对准结果的12项研究中，4个小型随机临床试验(RCTs)未发现组间差异有统计学意义,尽管它们只能检测到非常大的差异。8项非随机研究中有7项发现，在支持可调节缝合技术的情况下，运动对齐成功率存在统计学上的显着差异。在总体和某些亚组患者中。外斜视（在3项不限于儿童的研究中）和内斜视（在1项成人和2项儿童的研究中）都观察到了成功的运动对准。大多数纳入的研究报告的再手术率发现，在接受斜视手术的患者中，使用可调节缝线进行斜视手术的比率较低。但是这一发现没有得到统一的证明。
虽然没有I级研究评估斜视手术可调节缝线的有效性，大多数符合本评估纳入标准的非随机研究报告,在运动对位结局方面,可调整缝线技术优于不可调整缝线技术.在所有审查的研究中，这一发现并未得到统一证明，因此值得在可调节缝线技术的开发和分析中进行进一步研究。
文献检索没有产生I级研究。在符合纳入标准的17条条款中，11个被评为II级，6个被评为III级。在专注于运动对准结果的12项研究中，4个小型随机临床试验(RCTs)未发现组间差异有统计学意义,尽管它们只能检测到非常大的差异。8项非随机研究中有7项发现，在支持可调节缝合技术的情况下，运动对齐成功率存在统计学上的显着差异。在总体和某些亚组患者中。外斜视（在3项不限于儿童的研究中）和内斜视（在1项成人和2项儿童的研究中）都观察到了成功的运动对准。大多数纳入的研究报告的再手术率发现，在接受斜视手术的患者中，使用可调节缝线进行斜视手术的比率较低。但是这一发现没有得到统一的证明。
虽然没有I级研究评估斜视手术可调节缝线的有效性，大多数符合本评估纳入标准的非随机研究报告,在运动对位结局方面,可调整缝线技术优于不可调整缝线技术.在所有审查的研究中，这一发现并未得到统一证明，因此值得在可调节缝线技术的开发和分析中进行进一步研究。
