Scleral adjustment method: a novel and easy adjustable suture technique in strabismus surgery.

PURPOSE: To describe the scleral adjustment (SA) method, a double-pass, knot-free adjustable suture technique for strabismus surgery, and evaluate its clinical outcomes.

METHODS

The medical records of 14 consecutive patients treated with the SA method between December 2024 and May 2025 with ≥3-month follow-up were reviewed retrospectively. Suspension sutures from each muscle end were passed twice through the sclera near the original insertion. After initial surgery, patients returned to the operating room for binocular adjustment in an upright position.

RESULTS

Mean patient age was 60 ± 19 years, with mean number of adjustments performed per case of 1.4. Postoperative alignment was within 10Δ in all patients and remained stable. The SA method enabled precise microadjustments and facilitated simplified adjustments. No intraoperative or postoperative complications were observed.

CONCLUSIONS

The SA method is technically simple, avoids knot manipulation during adjustment, and enables precise microadjustments with secure fixation. Favorable outcomes in our small cohort suggest that it is a reliable alternative to sliding knot and bowtie techniques, with potential for mainstream application.