Long-term results after bimedial posterior fixation sutures for infantile esotropia

Abstract

Between 1984 and 1989, 79 patients were reexamined an average of 8 years after bimedial rectus muscle posterior fixation sutures. Patients who had to be operated additionally for vertical or cyclovertical motility disorders were excluded from the study. Seventy-five percent of the patients showed a residual deviation in the alternating prism and cover test of up to 5°. With Bagolini striated glasses 60 patients were found to have simultaneous perception at near and distance. The effects on convergence and lateral gaze were examined. After completed surgical therapy consecutive exotropia was found in 5% of all cases. In every 5th patient a reoperation was required. The study shows that bilateral posterior fixation suture of the medial rectus muscles leads to good long-term results in correcting infantile esotropia. Compared to other surgical techniques, significant advantage results from the low number of consecutive exotropias.

Revisiting Posterior Fixation Sutures Surgery: Unveiling Novel Approaches for Primary Management of Diverse Esotropia Cases

“…The surgery of choice is also not uniform. It includes bilateral MR recession [ 9 – 11 ], PFS with or without MR recession [ 3 , 12 ], three horizontal muscle surgery [ 13 ], botulinum toxin-augmented MR recessions [ 9 , 14 ] and Y-split recessions [ 15 ]. The median age at surgery was 3 years old, possibly due to cases not starting the follow-up in our department since early childhood.…”

“…Initially, it was designed to weaken the muscle solely within its field of action without affecting ocular alignment in the primary gaze [ 1 , 2 ]. However, its impact on the primary gaze is evident, leading some surgeons to prefer PFS over medial rectus (MR) recession as the initial treatment for esotropia [ 3 , 4 ]. In our department, bilateral and unilateral PFS procedures have been performed as the primary approach for various types of esotropia, even in cases without paresis or convergence excess, i.e.…”