title: Medial rectus pulley posterior fixation is as effective as scleral posterior fixation for acquired esotropia with a high AC/A ratio.
abstract: OBJECTIVE
  To compare traditional medial rectus (MR) scleral posterior fixation versus MR pulley posterior fixation without scleral sutures for the treatment of acquired esotropia (ET) with a high accommodative convergence over accommodation (AC/A) ratio.
  
  
  METHODS
  Nonrandomized interventional case series.
  
  
  METHODS
  Medical records were retrospectively reviewed for twenty-two patients who underwent bilateral MR posterior fixation for acquired ET with a high AC/A ratio, with or without associated MR recessions. The main outcome measure was the reduction in distance-near disparity created by MR scleral posterior fixation compared with MR pulley posterior fixation.
  
  
  RESULTS
  Nine patients underwent MR scleral posterior fixation surgery, seven in combination with MR recessions for distance ET. Postoperatively, the distance-near disparity decreased an average of 11.8 prism diopters, stereoacuity improved in six patients, and eight patients no longer needed bifocals. Thirteen patients underwent MR pulley posterior fixation surgery, 10 in combination with MR recessions for distance ET. Postoperatively the distance-near disparity decreased an average of 14.4 prism diopters, stereoacuity improved in eight patients, and 12 patients no longer required bifocals. Statistically, the two procedures were equivalent. One patient in each group was undercorrected at near only, with the residual near ET controlled with bifocals. One patient who underwent MR pulley posterior fixation combined with large MR recessions was overcorrected at distance only.
  
  
  CONCLUSIONS
  Traditional MR scleral posterior fixation and MR pulley posterior fixation are equally effective in treating acquired ET with a high AC/A ratio.
authors.affiliation: Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, USA. drraclark@yahoo.com
authors.forename: Robert A
authors.initials: RA
authors.lastname: Clark
authors.forename: Reginald
authors.initials: R
authors.lastname: Ariyasu
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Demer
mesh_terms: D000065:Accommodation, Ocular; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003290:Convergence, Ocular; D004948:Esotropia / Q000601:surgery*; D005139:Eyeglasses; D006801:Humans; D007223:Infant; D009801:Oculomotor Muscles / Q000601:surgery*; D012189:Retrospective Studies; D012590:Sclera / Q000601:surgery*; D013536:Suture Techniques