Journal of American Association for Pediatric Ophthalmology and Strabismus
Major articlesMedial rectus pulley posterior fixation: A novel technique to augment recession
Section snippets
Subjects and methods
After obtaining approval from the Institutional Review Boards at the Southern California Permanente Medical Group and the University of California, Los Angeles, a retrospective chart review was conducted to identify all patients operated by one of us (R.A.C.), who carried the following diagnoses: recurrent ET with excess near ET after prior bilateral MR recessions, primary unilateral surgery in patients with sensory ET with excess near ET, or primary bilateral MR recessions coupled with pulley
Results
We analyzed a total of 16 patients: 9 previously operated patients with excess near ET, 4 patients with sensory ET with excess near ET, and 3 patients with large-angle infantile ET. The results for the 9 patients with recurrent ET with excess near ET after prior bilateral MR recessions are summarized in Table 1. All of the patients had esotropia originally, either acquired or infantile, and underwent bilateral MR recessions as their primary surgery. Some of the patients had undergone subsequent
Discussion
This study supports previous work by demonstrating that MR pulley posterior fixation reduces MR force during convergence, decreasing excess near ET.8 In each study group, we observed a postoperative reduction in excess near ET averaging more than 10 prism diopters, consistent with the effect found in primary MR pulley posterior fixation for acquired esotropia with a high AC/A ratio.8 Given the small numbers in each group, comparative statistics between groups are not meaningful. A further
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Cited by (22)
Lateral rectus sag and recurrent esotropia in children
2019, Journal of AAPOSMagnetic Resonance Imaging of the Globe-Tendon Interface for Extraocular Muscles: Is There an “Arc of Contact”?
2018, American Journal of OphthalmologyComparison between medial rectus pulley fixation and augmented recession in children with convergence excess and variable-angle infantile esotropia
2016, Journal of AAPOSCitation Excerpt :In the pulley group, surgeries were performed via a limbal approach, and MR muscle recession was performed with the surgical dose targeting the smallest preoperative angle; in cases where the smallest angle was 0, a bilateral 3 mm recession was performed. The muscle was then fixated to its pulley as described.12,13 Patients were examined at 1 week, 1 month, 3 months, and 6 months after surgery.
Bilateral lateral rectus muscle recession with medial rectus pulley fixation for divergence excess intermittent exotropia with high AC/A ratio
2013, Journal of AAPOSCitation Excerpt :This novel technique was effective in augmenting medial rectus recession that is relatively greater at near fixation and successfully provided long-term mechanical restriction to medial rectus contraction that increases when the eye is rotated farther into adduction.6,10 They also reported that pulley posterior fixation was safer than conventional posterior fixation suture.5,6 In our experience, medial rectus pulley fixation was safer than the classic posterior scleral fixation because the pulley posterior fixation suture was not anchored to the sclera and thus there was no risk of scleral perforation.
New strabismus surgical techniques
2013, Journal of AAPOSCitation Excerpt :If not, the pulley suture may need to be replaced through deeper connective tissue or more posteriorly on the muscle belly. All published studies to date have focused on pulley posterior fixation of the medial rectus muscles, either to augment a maximal recession or to treat a high accommodative convergence/accommodation ratio in esotropia.3-6 Each study has shown equivalent effects compared with either concurrent or historical results from scleral posterior fixation.
Supported by U.S. Public Health Service, National Eye Institute: grant EY-08313 and core grant EY-00331. Joseph Demer received an unrestricted award from Research to Prevent Blindness and is David and Laraine Gerber Professor of Ophthalmology.