Bilateral posterior fixation sutures on the medial rectus muscles for correction of nonaccommodative esotropia with infantile onset criteria.

Abstract

Bilateral posterior fixation sutures on the medial rectus muscles can be used in the management of nonaccommodative esotropia with criteria indicative of infantile onset. The postoperative results of posterior scleral fixation of bilateral medial rectus muscles on ocular motility and the angle of esotropia in different directions of gaze, as well as on the near point of convergence, have been studied. Twenty-six patients suffering nonaccommodative esotropia of the infantile onset type, showing variable angles, adduction overshooting, and esodeviation, which had started within the first year of life, were examined. The angle of esotropia was measured at near, distance, and in the different directions of gaze. All patients underwent post-equatorial scleral fixation of both medial rectus muscles at 12 mm to 14 mm from the insertion, depending on the preoperative angle of esotropia. With the alternate prism cover test, 20 patients (76.9%) showed an angle <10 prism diopters (delta) in the primary position, as well as in the different directions of gaze. Fifteen of the 20 patients (57.7%) even showed simultaneous perception at near and at distance with Bagolini's striated glasses. Six patients were under-corrected. Bilateral posterior fixation of the medial rectus muscles is a good procedure to correct the angle of esotropia in patients who meet the following criteria: essential infantile esotropia, showing overacting medial rectus muscles, variable angles, and nonaccommodative convergence excess.