Medial Rectus Pulley (Posterior Fixation) Sutures

1
Medial Rectus Pulley (Posterior Fixation) Sutures
- Use in spectacle-intolerant children

• Logan Mitchell1, Lionel Kowal1,2
• Royal Victorian Eye and Ear Hospital, Melbourne
• Private Eye Clinic, Melbourne

2
Accommodative Esotropia -1st line treatment
correct full plus
3
Wear your glasses!(when 6/6 unaided...)

• Challenges well-recognised

4
For Spectacle-intolerant Children

• Options
• Contact lens
• Corneal refractive surgery
• Strabismus surgery
• concern late overcorrection due to decreased
  hyperopia with age
• very little in literature

5
Partially Accommodative Esotropia

• Surgery indicated
• Special cases If hyperopia low
• (less than 2.50)
• ?Appealing to aim for spectacle independence
• Concern re consecutive exotropia applies
  similarly

6
Medial Rectus Pulley(Posterior Fixation) Sutures
MR pulley suture (arrow) limits MR travel through
its pulley in adduction (C), compared to normal
situation (B)
7
EOM Pulleys
8
Medial Rectus Pulley(Posterior Fixation)
Sutures(also see YouTube pulley sutures)
9
Low-plus Cases (n3)
10
Spectacle-intolerant Cases (n3)
11
Parental Reluctance for Bifocals Case
2
12
Conclusions

• No overcorrections
• Limited follow-up
• 2/7 cases achieved spectacle independence
• NB child with improved behaviour after one year
  of spectacle-independence
• Medial Rectus Pulley Sutures not a particularly
  effective treatment for spectacle intolerant
  children