Results of a combined adjustable recession and posterior fixation suture of the same vertical rectus muscle for incomitant vertical strabismus

Abstract

Purpose: The posterior fixation suture (fadenoperation) is an effective treatment for complicated incomitant vertical strabismus. Traditional operative methods do not permit the simultaneous use of an adjustable recession of the same muscle. Methods: Seven patients with incomitant vertical strabismus and diplopia were treated with a combined adjustable recession and posterior fixation suture of the same vertical rectus muscle. Preoperative vertical misalignments in the primary position ranged from 4 to 10 prism diopters. Vertical incomitance from the primary position into the field of action of the recessed vertical rectus muscle ranged from 6 to 30 prism diopters (mean, 17 prism diopters). This was the sole operation in five patients and was combined with other vertical muscle surgery in two others. Results: All seven patients experienced improvement in their diplopia. Five of 7 patients (71%) required postoperative adjustments to achieve orthophoria in the primary position. This combined procedure reduced large deviations in the field of action of the recessed vertical muscle in all cases. Six of 7 patients (86%) did not require prismatic correction after this operation. One patient required prism only in his reading glasses. Conclusions: A combined adjustable recession and posterior fixation suture of the same vertical rectus muscle was effective in reducing or eliminating vertical incomitant strabismus.