1Medial 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
2Accommodative 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...
3Rx 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
4Medial Rectus Pulley Suture P = muscle suturedto its pulley.This nowrestricts full aDductionOriginal MR insertionAAP18ºPPULLEYBMedial orbital wallBMRMRA, B : ant & post extent of pulley sleeve
5Medial Rectus Pulley Sutures in Accommodative Esotropia
6Faden 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