NPOG 2009 Abstract template

Foredragsholder / Presenter

Navn / Name : Jonathan M. Holmes

Institusjon/Institution: Mayo Clinic, Rochester MN. USA

Avdeling / Department : Ophthalmology

Gate / Street: 200 First St SW, Rochester MN

Post nr. / zip code: 55905

Land / Country: USA

ABSTRACT

Lateral rectus posterior fixation sutures

Introduction: Several authors have suggested that a posterior fixation suture on the lateral rectus is ineffective, due to the muscle’s long arc of contact with the globe. Nevertheless, the technique might be effective if a posterior fixation suture could be placed sufficiently posterior.

Methods: Eight patients underwent posterior fixation suture on the lateral rectus combined with recession. Indications were 1) dissociated horizontal deviation, 2) contralateral medial rectus weakness from previous sinus surgery, and 3) incomitant exotropia following scleral buckle surgery on the contralateral eye. At surgery, the lateral rectus was disinserted from the sclera and a Mersilene posterior fixation suture was placed 17 to 19 mm back from the insertion. The lateral rectus was also simultaneously recessed on an adjustable suture. 3 cases also had a simultaneous medial rectus resection. Outcome was assessed by prism cover tests in primary and eccentric gaze positions, by ductions, and by field of single binocular vision if diplopic.

Results: In all cases, the lateral rectus posterior fixation suture induced the desired modest limitation of abduction, with resulting improvement in incomitance of the exotropia. Patients with pre-operative diplopia showed improvement of head posture, with improved field of single binocular vision.

Conclusions: A lateral rectus posterior fixation suture is useful in addressing incomitant exodeviations, and may have a role in exotropia associated with Duanes syndrome.