J Korean Ophthalmol Soc.  2013 Jul;54(7):1074-1078. 10.3341/jkos.2013.54.7.1074.

Comparison of Outcomes According to Surgical Method in Partially Accommodative Esotropia in Patients Over 4 Years of Age

• Seo JW
• Lee JY
• Paik HJ

• KMID: 2217418
• DOI: http://doi.org/10.3341/jkos.2013.54.7.1074

Abstract

PURPOSE
To compare postoperative outcomes according to surgical method in partially accommodative esotropia in patients over 4 years of age.
METHODS
We compared motor and sensory outcomes between conventional and augmented surgery in 66 patients. The postoperative follow-up period was at least 24 months. The formula for the amount of the rectus muscle recession was based on the distant angle deviation after hyperopic correction in the conventional group and the average amounts of the distant angle deviation with and without full correction of hyperopia in the augmented group. In addition, the conventional group was divided into 2 sub-groups to compare surgical outcomes. The A group consisted of patients who underwent surgery with the amount of surgical correction based on distant angle deviation after full hyperopic correction. The B group consisted of patients under the same condition after reduced hyperopic correction to achieve best corrected visual acuity (BCVA).
RESULTS
Among the patients who had an ocular alignment less than 10 PD, orthophoria was significantly higher in the conventional group than in the augmented group on the last follow-up. When comparing the 2 conventional sub-groups, the postoperative stereoacuity was better in group B than in group A. Among patients with a postoperative overcorrected alignment of more than 10 PD who underwent augmented surgery, 75% showed decreased postoperative stereoacuity compared to preoperative stereoacuity.
CONCLUSIONS
In partially accommodative esotropia in patients over 4 years of age, conventional surgery compared to augmented surgery after reduced hyperopic correction is better in order to achieve BCVA for postoperative stereoacuity as well as ocular alignment.

Keyword

Augmented surgery; Conventional surgery; Partially accommodative esotropia; Stereoacuity; Surgical outcome

MeSH Terms

Esotropia
Follow-Up Studies
Humans
Hyperopia
Muscles
Visual Acuity

Reference

References

1. Kim EJ, Cho YA. Clinical assessment of partially accommodative esotropia. J Korean Ophthalmol Soc. 1993; 34:447–51.

2. von Noorden GK. Binocular vision and ocular motility, 6th ed. St. Louis:: CV Mosby;2002. p. 319–20.

3. Ludwig IH, Parks MM, Getson PR, Kammerman LA. Rate of dete-rioration in accommodative esotropia correlated to the AC/A relationship. J Pediatr Ophthalmol Strabismus. 1988; 25:8–12.

4. Lee JY, Kim JK, Cho YA. The longterm postoperative alignment and binocularity of partially accommodative esotropia. J Korean Ophthalmol Soc. 2000; 41:1974–82.

5. Scott WE, Thalaker JA. Preoperative prism adaptation in acquired esotropia. Ophthalmologica. 1984; 189:49–53.

6. Burian HM. Hypermetropia and esotropia. J Pediatr Ophthalmol Strabismus. 1972; 9:135–43.

7. Prism Adaptation Research Group. Efficacy of prism adaptation in the surgical management of acquired esotropia. Arch Ophthalmol. 1990; 108:1248–56.

8. Kim JC, Park SC, Park C. The clinical effect of augmented surgery for partially accommodative esotropia. J Korean Ophthalmol Soc. 1995; 36:505–9.

9. Kim YK, Kong SM. Augmented surgery for partially accom-modative esotropia. J Korean Ophthalmol Soc. 2000; 41:2401–7.

10. Jotterand VH, Isenberg SJ. Enhancing surgery for accommodative esotropia. Ophthalmic Surg. 1988; 19:263–6.

11. Kushner BJ, Preslan MW, Morton GV. Treatment of partly accom-modative esotropia with a high accommodative convergence- accommodation ratio. Arch Ophthalmol. 1987; 105:815–8.

12. Wright KW, Bruce-Lyle L. Augmented surgery for esotropia asso-ciated with high hypermetropia. J Pediatr Ophthalmol Strabismus. 1993; 30:167–70.

13. Kushner BJ. Partly accommodative esotropia: Should you over-correct and cut the plus? Arch Ophthalmol. 1995; 113:1530–4.

14. Dankner SR, Mash AJ, Jampolsky A. Intentional surgical over-correction of acquired esotropia. Arch Ophthalmol. 1978; 96:1848–52.

15. Arnoldi K. Long-term surgical outcome of partially accommodative esotropia. Am Orthopt J. 2002; 52:75–84.