Efficacy of Posterior Myopexy (Fadenoperation) Combined with Conventional Horizontal Strabismus Surgery for Esotropia with Distance–Near Incomitance: A Retrospective Observational Study

Abstract

Aims: To evaluate the postoperative outcomes of posterior myopexy in terms of surgical success and stability at short, medium, and long-term follow-up. Study Design: Retrospective observational study. Place and Duration of Study: Ophthalmology Department, Regional Hospital of Kasserine, Tunisia; surgeries performed between 2019 and 2021, with follow-up ranging from 5 months to 2 years (mean: 1.2 years). Methodology: We retrospectively reviewed the medical records of 20 patients with concomitant esotropia associated with distance-near incomitance and/or medial rectus muscle spasm who underwent posterior myopexy combined with conventional horizontal strabismus surgery. Pre- and postoperative deviations were measured using prism cover testing. Postoperative alignment was assessed at 3, 6, and 12 months of follow-up. Surgical success was defined as a residual deviation ≤ 10 prism diopters (PD). Stability was defined as a difference ≤ 6 PD in distance deviation between the 1-month and 12-month postoperative assessments. Results: Twenty patients were included (mean surgical age: 8.9 ± 2.1 years; mean follow-up: 1.2 ± 1.1 years), of whom 8 had early esotropia, 11 partially accommodative esotropia, and 1 acquired non-accommodative esotropia. Preoperatively, the mean deviations under full optical correction were 30.4 PD at distance, 37.2 PD at near, with a mean distance–near incomitance of 9 PD. All patients underwent bilateral posterior myopexy, performed as an isolated procedure in 3 cases and combined with horizontal muscle surgery in 17 cases. Postoperatively, the mean residual deviations were ≤ 7.5 PD at all follow-ups, and distance–near incomitance was nearly abolished. The reduction in mean distance deviation from preoperative values was statistically significant at all time points (30.4 PD to 6.75 PD at 3 months; p < 0.001. Surgical success (residual deviation and incomitance < 10 PD) was achieved in 95% of patients at 3 months and 85% at 12 months, with stable alignment (≤6 PD change between 1 and 12 months) in 19 of 20 cases. No significant intraoperative or postoperative complications were observed, and patients reported high aesthetic and psychological satisfaction Conclusion: Posterior myopexy combined with conventional horizontal strabismus surgery appears to provide a high rate of surgical success and long-term angular stability in patients with concomitant esotropia associated with distance-near incomitance greater than 10 PD or medial rectus.