Strabismus - Fundamentals of Clinical Ophthalmology.pdf

STRABISMUS
Figure 7.7
Recession with “hang-back” suture
deviation but help in correcting vertical
deviation (Figure 7.8).
The value of a posterior fixation suture
(Faden procedure) is demonstrated, for
example, in those cases where the deviation is
greater for near than distance.
Myectomy, marginal
myotomy, and tenotomy
The commonest indication for complete
myectomy is marked overaction of the inferior
oblique muscle. Marginal myotomy is a useful
procedure to further weaken a muscle, for
example after a bilateral medial rectus recession
for congenital esotropia. Complete tenotomy of
the superior oblique combined with weakening
of the inferior oblique has an accepted place
in management of Brown syndrome. Whilst
complete myectomy may have a place in marked
overaction of the inferior oblique muscle,
recession gives more options. In moderate
inferior overaction, recession avoids converting
inferior oblique overaction with a V pattern to an
A pattern. It is also important in the recession of
inferior oblique to dissect and isolate the
insertion of the muscle (Figure 7.9).
Transposition
Transposition of the horizontal rectus
muscles in a vertical direction and changing the
(a)
(b)
Figure 7.8 (a) Small residual entropia following
initial bilateral medial rectus recession surgery. (b)
Fully corrected deviation with glasses postoperatively,
in contrast to preoperatively when glasses were of no
value.
alignment of horizontal recti is performed in the
management of A and V syndromes where there
is no obvious oblique dysfunction.
82