Posterior fixation suture and convergence excess esotropia.

The present study investigates the results of Cuppers' 'Fadenoperation' in patients with non-accommodative convergence excess esotropia. Particular attention is given to postoperative eye alignment at distance fixation. Group 1 (n=96) included patients with a 'normal' convergence excess. The manifest near angles (mean ET 16.73 degrees +/- 6.33 degrees, range 4 degrees -33 degrees ) were roughly twice the size of the distance angles (mean ET 6.50 degrees +/- 3.62 degrees, range 0 degrees -14 degrees ). These patients were treated with a bilateral fadenoperation of the medial recti without additional eye muscle surgery. Three months after surgery, the mean postoperative angles were XT 0.5 degrees +/- 3.3 degrees (range XT 11 degrees -ET 5 degrees ) for distance fixation, and ET 2.7 degrees +/- 3.6 degrees (range XT 5 degrees -ET 14 degrees ) for near fixation, respectively. Postoperative convergent angles at near fixation >ET 10 degrees were present in two patients (1.9%). Group 2 (n=21) included patients with a mean preoperative distance angle of ET 9.2 degrees +/- 3.7 degrees (range 6 degrees -16 degrees ) and a mean preoperative near angle of ET 23.4 degrees +/- 3.1 degrees (range 16 degrees -31 degrees ). These patients were operated on with a bilateral fadenoperation of the medial recti and a simultaneous recession of one or both medial rectus muscles. Mean postoperative angles were XT 0.5 degrees +/- 4.6 degrees (range XT 12 degrees -ET 7 degrees ) for distance fixation and ET 1.4 degrees +/- 4.5 degrees (range XT 8 degrees -ET 13 degrees ) for near fixation, respectively. In this group, 2 patients (10.6%) had a postoperative exotropia >XT 5 degrees at distance fixation, and two patients had residual esotropia>ET 10 degrees at near fixation. Group 3 (n=17) included patients with a pronounced non-accommodative convergence excess. Near angle values (mean of 17.8 degrees +/- 5.3 degrees, range ET 7 degrees -26 degrees ) were several times higher than the distance angle values (mean ET 1.9 degrees +/- 4.2 degrees, range XT 3 degrees -ET 6 degrees ). These patients were treated with a bilateral fadenoperation of the medial recti and a simultaneous resection of one or both medial rectus muscles. Mean postoperative angles were ET 0.2 degrees +/- 4.7 degrees (range XT 8 degrees -ET 6 degrees ) for distance fixation and 5.3 degrees +/- 6.1 degrees (range XT 3 degrees -ET 12 degrees ) for near fixation, respectively. One patient had a postoperative distance angle >XT 5 degrees, whereas two patients displayed postoperative convergent angles >ET 5 degrees at near fixation.