Retroequatorial myopexy combined with bimedial recession for near-distancedisparity esotropia

Purpose: In cases of esotropia combined with a high AC/A ratio, partly acco mmodative convergence excess or with nonaccommodative convergence excess, t wo methods of surgical therapy are possible: recession of the medial recti (Parks) and retroequatorial myopexy (Cuppers). Our aim was to answer the qu estion whether retroequatorial myopexy alone and in combination with bimedi al recession are appropriate methods of reducing the strabismic angle at ne ar and distant fixation to values under 10 PD and near-distance disparity t o less than 10 PD to form the basis for single binocular vision without bif ocals. Patients and methods: Eighty-three patients, aged 2-14 years (39 boys and 4 4 girls), were included in the study: 37 children (group A) with early-onse t near-distance esotropia of 14-48 PD for distance and 26-65 PD for near ob jects and 46 children (group B) with acquired near-distance esotropia of 8- 45 PD for distance and 26-70 PD for near objects. Inclusion criteria were a near-distanced disparity of at least 10 PD (range 10-33 PD), a follow-up o f at least 3 months (median 5 months, range 3-69 months), retinoscopy in cy cloplegia and full refractive correction. The amount of conventional surger y was chiefly based on the distance angle of esotropia. The myopexy was pla ced 12, 13 and 14 mm behind the insertion of the medial rectus. Results: In 73 of 83 patients (88 %) we were able to reduce the strabismic: angle for distance and near fixation to less than 10 PD and in 73 cases ev en under 5 PD. In 77 of 83 patients (93 %) the near-distance disparity was reduced to less than 10 PD and in 72 patients (87 %) even under 5 PD. Posto peratively, 9 children had bifocals, but 3 of them have meanwhile discarded them. Two cases were slightly ocvercorrected and 1 case undercorrected. Se venty children (84 %) attained grade of binocularity. Conclusion: Retroequatorial myopexy (fadenoperation) alone and combined wit h bimedial recession is an effective procedure in treating esotropia with a bnormal near-distance disparity.