{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:03:10Z","timestamp":1759449790192,"version":"build-2065373602"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Klin Monbl Augenheilkd"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n               Background In addition to the bimedial recession of the rectus muscle, two surgical procedures are available to reduce torque: retro-equatorial myopexy (C\u00fcppers-Fadenoperation) and the Y-split of the medial rectus muscle. The aim of this study is to compare the safety and efficacy of the latter two surgical techniques.<\/jats:p><jats:p>\n               Methods Data from 113 consecutive patients who presented for surgical treatment of convergence excess at the University Hospital of W\u00fcrzburg between October 2006 and October 2020 were retrospectively analysed. In 2006\u200a\u2013\u200a2014. All patients underwent retro-equatorial myopexy, whereas from 2015 onwards, Y-splitting was the treatment of choice. Orthoptic examinations were performed preoperatively, on the first postoperative day, four months postoperatively and in the longer postoperative course \u2013 always with full correction of hyperopia as measured in cycloplegia. The distance and near squint angles in the alternating cover test, the convergence excess and the complication rate as well as the need for repeat surgery were measured.<\/jats:p><jats:p>\n               Results Both retro-equatorial myopexy and Y-splitting significantly reduced the far and near strabismus angles and convergence excess in all postoperative controls, with no significant difference between the two groups at the four-month follow-up (Levene\u02bcs variance homogeneity test [far angle p\u2009=\u20090.151; near angle p\u2009=\u20090.114]). The incidence of intraoperative complications and the need for reoperation for over- and undercorrection were slightly lower with the Y-split.<\/jats:p><jats:p>\n               Conclusion Both retro-equatorial myopexy and Y-splitting of the medial rectus muscle are suitable surgical procedures for the treatment of convergence excess. Y-splitting appears to be safer intraoperatively and easier to learn, due to the absence of retro-equatorial fixation, which is associated with fewer complications. However, revision may be more difficult, this should be considered in the event of loss of information regarding the Y-splitting technique and written documentation of the procedure should always be provided.<\/jats:p>","DOI":"10.1055\/a-2543-1425","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T18:33:54Z","timestamp":1747852434000},"page":"570-577","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Two Surgical Methods for the Treatment of Convergence Excess: Y-Split and Retro-equatorial Myopexy of the Medial Rectus Muscle"],"prefix":"10.1055","volume":"242","author":[{"given":"Christoph","family":"Kalantari","sequence":"additional","affiliation":[{"name":"Strabologie, Neuroophthalmologie und Kinderaugenheilkunde, Universit\u00e4ts-Augenklinik W\u00fcrzburg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Ehrt","sequence":"additional","affiliation":[{"name":"Augenheilkunde, Augenklinik der Ludwig-Maximilians-Universit\u00e4t, M\u00fcnchen, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin M.","family":"Nentwich","sequence":"additional","affiliation":[{"name":"Strabologie, Neuroophthalmologie und Kinderaugenheilkunde, Universit\u00e4ts-Augenklinik W\u00fcrzburg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","DOI":"10.1055\/b-006-149523","volume-title":"Strabismus","author":"H Steffen","year":"2020"},{"key":"ref2","first-page":"579","article-title":"Moderne Schielbehandlung","volume":"129","author":"C C\u00fcppers","year":"1956","journal-title":"Klin Monbl Augenheilkd Augenarztl Fortbild"},{"volume-title":"Die sogenannte Fadenoperation (1974)","author":"C C\u00fcppers","key":"ref3"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1016\/s0002-9394(99)00356-6","article-title":"Posterior fixation sutures: a revised mechanical explanation for the fadenoperation based on rectus extraocular muscle pulleys","volume":"128","author":"R A Clark","year":"1999","journal-title":"Am J Ophthalmol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1034\/j.1399-6576.2001.450110.x","article-title":"Myopexy (Faden) results in more postoperative vomiting after strabismus surgery in children","volume":"45","author":"M Saiah","year":"2001","journal-title":"Acta Anaesthesiol Scand"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"145","DOI":"10.3928\/0191-3913-19930501-04","article-title":"Progressive overcorrection after inferior rectus recession","volume":"30","author":"D T Sprunger","year":"1993","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1080\/0065955X.1977.11982421","article-title":"The faden operation: mechanical effects","volume":"27","author":"A B Scott","year":"1977","journal-title":"Am Orthopt J"},{"key":"ref8","first-page":"173","article-title":"L\u02bcexp\u00e9rience de trois ann\u00e9es de l \u201eop\u00e9ration du fil\u201c de C\u00fcppers dans les interventions contre l\u02bc\u00e9sotropie avec ph\u00e9nom\u00e8ne innervationnel de blocage","volume":"88","author":"C Thomas","year":"1976","journal-title":"Bull Mem Soc Fr Ophtalmol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1159\/000309958","article-title":"Length-tension diagrams of medial rectus muscles after C\u00fcppers\u02bc fadenoperation. Surgical assessment of the reversibility of posterior fixation sutures","volume":"198","author":"A M Castanera","year":"1989","journal-title":"Ophthalmologica"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.1136\/bjo.2004.042721","article-title":"Reduction of ocular muscle torque by splitting of the rectus muscle II: technique and results","volume":"88","author":"R Hoerantner","year":"2004","journal-title":"Br J Ophthalmol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1111\/j.1600-0420.2007.00933.x","article-title":"A comparison of two different techniques for oculomotor torque reduction","volume":"85","author":"R Hoerantner","year":"2007","journal-title":"Acta Ophthalmol Scand"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1136\/bjo.2004.042713","article-title":"Reduction of ocular muscle power by splitting of the rectus muscle I: biomechanics","volume":"88","author":"T Haslwanter","year":"2004","journal-title":"Br J Ophthalmol"},{"volume-title":"Medial rectus Y-splitting vs. Faden-operation for the treatment of infantile esotropia with convergence excess or cross-fixation [Vortrag]. Annual Meeting of European Stabismological Association (ESA)","year":"2011","author":"O Ehrt","key":"ref13"},{"key":"ref14","first-page":"25","article-title":"The Faden operation. Technical aspects and indications","volume":"232","author":"P Roggenk\u00e4mper","year":"1989","journal-title":"Bull Soc Belge Ophtalmol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1055\/s-2008-1057178","article-title":"Zum Wirkungsprofil der Fadenoperation","volume":"178","author":"H G Conrad","year":"1981","journal-title":"Klin Monbl Augenheilkd"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1055\/s-2008-1055009","article-title":"Ergebnisse der Fadenoperation nach C\u00fcppers","volume":"180","author":"H Kaufmann","year":"1982","journal-title":"Klin Monbl Augenheilkd"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1055\/s-2008-1057289","article-title":"Die chirurgische Korrektur der Esotropien mit instabilem Winkel (retro\u00e4quatoriale Myopexie)","volume":"179","author":"F Moro","year":"1981","journal-title":"Klin Monbl Augenheilkd"},{"key":"ref18","first-page":"141","volume-title":"Muscle splitting in the surgery of strabismus","author":"B Bagolini","year":"1991"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"3408614","DOI":"10.1155\/2018\/3408614","article-title":"Comparative Study of Y-Split Recession versus Faden Technique for Management of Infantile Esotropia in Egyptians","volume":"2018","author":"N Badawi","year":"2018","journal-title":"J Ophthalmol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"3386","DOI":"10.1177\/1120672120965494","article-title":"Modified Y-split and recession of medial rectus muscles in convergence excess esotropia","volume":"31","author":"A Bagheri","year":"2021","journal-title":"Eur J Ophthalmol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"6472690","DOI":"10.1155\/2017\/6472690","article-title":"Y-Split Recession of the Medial Rectus Muscle as a Secondary and\/or Unilateral Procedure in the Treatment of Esotropia with Distance\/Near Disparity","volume":"2017","author":"M Wipf","year":"2017","journal-title":"J Ophthalmol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"109","DOI":"10.3109\/09273972.2012.702323","article-title":"Isolated y-splitting and recession of the lateral rectus muscle in patients with exo-Duane syndrome","volume":"20","author":"F G Velez","year":"2012","journal-title":"Strabismus"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.jaapos.2013.11.021","article-title":"Isolated lateral rectus recession with Y splitting versus anchoring of the lateral rectus muscle in patients with exotropic Duane syndrome","volume":"18","author":"J Sukhija","year":"2014","journal-title":"J AAPOS"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"262","DOI":"10.3928\/01913913-20140819-05","article-title":"Surgical outcome of graded Y split in patients with Duane\u02bcs retraction syndrome","volume":"51","author":"S C Ganesh","year":"2014","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"523","DOI":"10.5301\/ejo.5000746","article-title":"Y-split recession vs. isolated recession of the lateral rectus muscle in the treatment of vertical shooting in exotropic Duane retraction syndrome","volume":"26","author":"M FA Farid","year":"2016","journal-title":"Eur J Ophthalmol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1007\/s00417-018-4181-8","article-title":"Adhesion after Y-split procedure can affect its mechanism for treating overshoots in Duane\u02bcs syndrome","volume":"257","author":"Y Choi","year":"2019","journal-title":"Graefes Arch Clin Exp Ophthalmol"}],"container-title":["Klinische Monatsbl\u00e4tter f\u00fcr Augenheilkunde"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2543-1425.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T23:38:40Z","timestamp":1759361920000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2543-1425"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":26,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2025,5,21]]},"published-print":{"date-parts":[[2025,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2543-1425","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0023-2165","1439-3999"],"issn-type":[{"type":"print","value":"0023-2165"},{"type":"electronic","value":"1439-3999"}],"subject":[],"published":{"date-parts":[[2025,5]]}}}