Abstract
Purpose: :
To obtain binocularity in primary and down reading gaze, weakening (recession) or strengthening (advancement or resection) procedures are often adequate. To maximize the area of binocular single vision, more aggressive weakening procedures may be necessary. The use of posterior fixation sutures functionally limits the excursion of an otherwise normal muscle. When combined with a recession procedure and applied to the contralateral synergist to a paralyzed muscle, or to the contralateral antagonist to a restricted muscle the area of binocularity can be substantially improved.
Methods: :
This is a retrospective review of 33 patients treated with posterior fixation sutures at the University of Virginia over a 10 year period. Patients were assessed for alignment in primary and down reading gaze, but also for increase in binocularity as measured by binocular single vision fields and for equalization based on Hess screen analysis.
Results: :
A total of 33 patients were treated with posterior fixation suture procedures. Sixteen patients were treated with medial rectus recession and Faden procedure for long standing stable abduction deficits (most commonly VI nerve dysfunction). Nine patients were treated with lateral rectus recession and posterior fixation sutures for contralateral adduction deficits usually related to III nerve dysfunction. One patient was treated with a contralateral superior rectus recession and Faden procedure for a surgically induced Brown syndrome following a tuck procedure for a IV nerve palsy. Seven patients had inferior rectus recession for problems with down gaze.
Conclusions: :
Posterior fixation sutures by limiting excursion of the better moving eye are an effective way of expanding binocularity. This is applicable to both paretic and restrictive syndromes. The area of binocularity and alignment can be fine tuned by additional surgery on the worse moving eye following the initial recession and Faden procedure. The use of the Hess screen and binocular single vision fields is instrumental in guiding surgery.
Keywords: strabismus: treatment • eye movements