[Surgical treatment of squint today. A status determination]

Abstract

The treatment of choice for eso- and exodeviations with variable angle and/or convergence excess or eye muscle palsy with diplopia in the gaze field of the paretic muscle is--at least in Central Europe--posterior fixation sutures (Cüpper's suture operation). The scleral sutures are critical in this procedure. More reliable results can be obtained if the sclera is scarified meridionally at the suture site. Sufficient experience with guarantee stable results, even though the procedure is difficult. Tucking of the rectus muscles is gaining increasing acceptance as a less traumatic alternative to resection since with this procedure the vasculature of the insertion is conserved to some extent. Significant sursumduction or deorsumduction of 15 degrees or more and corresponding trochlear palsies can be treated by combined recess-tuck procedures on the oblique muscles (e.g., tucking of the superior oblique and recession of the inferior oblique in the same eye). A combined procedure is more effective than successive operations and side effects are minimized (e.g., consecutive Brown's syndrome). Differing amounts of vertical and torsional deviation can be treated with differential surgery on the margin of the oblique muscles. Dissociated vertical deviation should not be taken for sursumduction caused by inferior oblique overaction (reversed fixation test), as straightforward weakening of the inferior oblique muscles may have serious consequences in the former condition. Surgical treatment of Duane's syndrome should be based on the amant of head posture and on the angle of deviation and retraction in the primary position.(ABSTRACT TRUNCATED AT 250 WORDS)