Posterior fixation suture and convergence excess esotropia.

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Pediatric Ophthalmology

Background:

• Non-accommodative convergence excess esotropia is a condition where the eyes turn inward excessively, particularly during near tasks, without a clear link to focusing ability.
• Accurate eye alignment is crucial for binocular vision and visual development, making effective treatment of esotropia essential.
• Cuppers' 'Fadenoperation' is a surgical technique that modifies the action of specific eye muscles to correct deviations.

Purpose of the Study:

• To evaluate the efficacy of Cuppers' 'Fadenoperation' in correcting non-accommodative convergence excess esotropia.
• To assess postoperative eye alignment at both distance and near fixation following the Fadenoperation.
• To compare outcomes in different patient groups based on the severity of their convergence excess.

Main Methods:

• Retrospective analysis of 134 patients with non-accommodative convergence excess esotropia.
• Patients were categorized into three groups based on preoperative angle measurements and surgical approach.
• Surgical interventions included bilateral medial rectus Fadenoperation, with or without additional recession or resection of medial rectus muscles.

Main Results:

• In Group 1 (normal convergence excess), postoperative alignment showed a mean of XT 0.5 degrees at distance and ET 2.7 degrees at near, with only 1.9% having significant residual esotropia.
• Group 2 (moderate convergence excess with recession) achieved a mean of XT 0.5 degrees at distance and ET 1.4 degrees at near, with some patients experiencing residual esotropia or exotropia.
• Group 3 (pronounced convergence excess with resection) demonstrated a mean of ET 0.2 degrees at distance and ET 5.3 degrees at near, with a small percentage showing residual deviations.

Conclusions:

• Cuppers' 'Fadenoperation', alone or combined with other muscle surgeries, is an effective treatment for non-accommodative convergence excess esotropia.
• The surgical approach should be tailored to the severity of the preoperative deviation for optimal outcomes.
• The Fadenoperation generally leads to successful alignment, with low rates of significant residual strabismus.