Treatment of partly accommodative esotropia with a high accommodative convergence-accommodation ratio
B. J. Kushner, M. W. Preslan and G. V. Morton
We conducted a prospective, randomized, masked comparison of two treatments
for the nonaccommodative element in esotropic patients with a high
accommodative convergence-accommodation ratio. One group received symmetric
medial rectus recessions with posterior fixation sutures; the other
received symmetric medial rectus recessions without posterior fixation
sutures but augmented according to formula taking into account the near
deviation. Previous experience had suggested that our surgical formula
based solely on the distance deviation would lead to excessive
undercorrections. A higher percentage of the augmented recession group
achieved satisfactory alignment and were able to discontinue wearing
bifocals postoperatively than the posterior fixation group. The data also
showed a trend (though not statistically significant) suggesting that more
members of the augmented recession group were able to discontinue wearing
spectacles entirely. We concluded that the posterior fixation suture
technique is not as effective as the augmented recession technique for the
treatment of partly accommodative esotropia with a high accommodative
convergence-accommodation ratio.
