Long-term outcome of medial rectus recession and pulley posterior fixation in esotropia with high AC/A ratio.
OBJECTIVE
Medial rectus (MR) recession with pulley posterior fixation (PF) can be used to treatesotropia (ET) with a high accommodative convergence to accommodation (AC/A) ratio as effectively in the short term as MR recession with scleral PF. This study provides a novel examination of the long-term results of MR recession with pulley PF (PPF).


METHODS
In 21 children we performed bilateral MR recession and pulley PF for ET greater at near than distance (high AC/A). Mean follow-up was 3.5 ± 2.5 (standard deviation [SD]) years.


RESULTS
Mean age at presentation was 2.7 ± 1.8 and at surgery 4.3 ± 1.6 years. Fourteen (67%) children had amblyopia. Distance and near pre-operative ET averaged 19.6Δ ± 10.5Δ and 36.9Δ ±18.9Δ, respectively. Mean near-distance (N-D) disparity was 16.4Δ ± 12.3Δ. The MR recession averaged 4.4 ± 0.9 mm. Early mean postoperative ET was 1.3 ± 3.3Δ at distance and 2.8Δ ± 5.2Δ at near. Mean late postoperative ET was 0.1Δ ± 5.8Δ and 1.0Δ ± 6.2Δ at distance and near, respectively. At the final postoperative examination, mean N-D disparity was reduced to 0.9Δ ± 3.6Δ.


CONCLUSIONS
MR recession with PPF has a high long-term effectiveness, even in patients with amblyopia and autism. Since no posterior scleral suturing is required, it minimizes the perforation risk associated with scleral PF.


CONCLUSIONS
MR recession with PPF is a safe and highly effective long-term treatment for ET with high AC/A ratio. Long-term results may surpass those of alternate procedures.
Jules Stein Eye Institute, Department of Ophthalmology, University of California, Los angeles, Los Angeles, CA 90095-7002, USA.
Geoffrey
G
Wabulembo
Joseph L
JL
Demer
D000065:Accommodation, Ocular / Q000502:physiology*; D002675:Child, Preschool; D003290:Convergence, Ocular; D004948:Esotropia / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D011184:Postoperative Period; D012189:Retrospective Studies; D012590:Sclera / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology*