1 Medial Rectus Pulley (Posterior Fixation) Sutures - Use in partially accommodative esotropia with convergence excessLogan Mitchell1, Lloyd Bender1,Avinash Mahindrakar1, Elaine Wong1,Elina Landa1, Lionel Kowal1,2Royal Victorian Eye and Ear Hospital, MelbournePrivate Eye Clinic, Melbourne
2 Accommodative Esotropia with Convergence Excess Example: ET 35, ET' 55Surgical undercorrections commonParks' formula:distance angle + 1 mm = 6.0 mmKushner's formula:distance angle + 10% of disparity = 7.0 mmNB = operating for near angleetc...
3 Rx of Very large amounts of Convergence Excess ET 15 ET’ 50What surgical dosage BMR?BMR (even with augmented dose) unlikely to correct near and distance deviation
4 Medial Rectus Pulley Suture P = muscle suturedto its pulley.This nowrestricts full aDductionOriginal MR insertionAAP18ºPPULLEYBMedial orbital wallBMRMRA, B : ant & post extent of pulley sleeve
5 Medial Rectus Pulley Sutures in Accommodative Esotropia
6 Faden Sutures: a revised explanation for their effect Clark et al, AJO 1999Primary gaze18 degrees ADdOriginal MR insertionAA18ºPPPULLEYBBMedial orbital wallP prevents normal MR movement through MR pulley - Adductionrestrictedby P ..as well as its effect on moment armMRMRA, B : ant & post extent of pulley sleeve