Long-Term Surgical Outcome of Partially Accommodative Esotropia
Partially accommodative esotropia is an acquired strabismus characterized by high hyperopia, a normal AC/A ration, and a deviation that responds only partially to spectacle correction. Surgery is done for the non-accommodative portion of the deviation. Over-corrections are managed by reducing the hyperopic power of the spectacles. This retrospective study was done to determine the risk factors for a poor surgical outcome, and to evaluate the efficacy of hyperopic spectacle reduction in the long-term management of consecutive exotropia.
Of the 108 patients enrolled, 19% had a residual esotropia, 37% were surgical successes, and 44% developed consecutive exotropia. Residual ET was associated with deteriorated refractive esotropia, moderate to sever amblyopia, and increasing hyperopia with age. Consecutive XT was associated with a distance-near disparity, low hyperopic refractive error, anisometropia, poor binocular vision, and under-correction of the hyperopic refractive error prior to surgery. Intentional reduction of the hyperopic correction was not successful in the long-term management of consecutive XT. Fifty-eight percent of those managed in this manner developed a pseudo-dissociated horizontal deviation. The high rate of consecutive exotropia following standard surgery suggests that augmented surgery for partially accommodative esotropia is highly likely to result in over-correction.