THE EFFICACY OF THE POSTERIOR FIXATION SUTURE ALONE AND COMBINED WITH BIMEDIAL RECTUS RECESSION FOR TREATMENT OF DISTANCE-NEAR DISPARITY ESOTROPIA
N. Stärk, A. Zubcov, K. Vanselow
It is the purpose of this paper to analyze the surgical results of esotropic patients with abnormal distance-near relationship. Parks (24) was the first to suggest the bimedial recession and later the fadenoperation described by Cüppers (3,4) was employed to correct these abnormalities. We wanted to know how effective the posterior fixation suture is alone (in small angle esotropias) and in combination with bimedial recession in manifest esotropia of greater than 10 PD at distance fixation and convergence excess of at least 10 PD. In large angle esotropias we even resected 1 lateral rectus muscle additionally.
Subjects: We conducted a retrospective study of 83 children (age range 2-14 years, mean age 5,4 years): 37 children had an early onset esotropia and 46 children an acquired esotropia. Inclusion criteria were consistent esotropia at distance fixation with high AC/A ratio (range 10-35 PD), and follow up time of 3 months at least. Exclusion criteria were profound amblyopia, previous muscle surgery and variable strabismic angle. The pre- and postoperative data were stored in a base strabismus program (Access), which is compable to other commercially available programs such as Excel 7,0, HG 3,0.
Results: 76 patients (92%) had a reduction of the disparity in the near/distance deviation to less by than 10 PD and 72 patients (87%) to less than 5PD. The pre- and postoperative data of strabismic angle at distance and near fixation of each case were plotted in easily understandable graphics. Postoperatively, 6 children (7%) achieved bifoveal fusion with stereoacuity 40-60", 33 (40%) had stereopsis of 80-800". 12 children (14%) Bagolini posi6ve and stereopsis of 3000" (Titmus fly) and 18 children (22%) had Bagolini positive at distance and near without any stereopsis. Only 10 children (12%) were ordered bifocals postoperatively, 2 of these have already discontinued them by now. Only 2 children were reoperated by now: one was overcorrected, the other undercorrected.
Conclusion: Posterior fixation suture alone or combined with bimedial recession is an effective addition to the treatment armentarium for esotropic patients with abnormal distance-near disparity.
Universitäts-Augenklinik, Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt