Partly accommodative esotropia. Should you overcorrect and cut the plus?
B. J. Kushner
Department of Opthalmology and Visual Sciences, University of Wisconsin-Madison, USA.
OBJECTIVES: To investigate the long-term motor stability and sensory
outcome of patients with partly accommodative esotropia who were
overcorrected surgically and in whom the hyperopic correction was reduced
postoperatively, and to determine if those results depended on the amount
of hyperopia present. DESIGN: A 15-year prospective study that analyzed
5-year outcome. Patients whose esotropia was not initially overcorrected
were used as controls. PATIENTS: Of 382 patients who underwent surgery for
partly accommodative esotropia, 22 were surgically overcorrected and were
followed up for 5 years. RESULTS: Of the eight patients in the study group
with 2.5 diopters or less of hyperopia in their fixing eye, seven had good
motor alignment compared with four of 14 patients who had more than 2.5
diopters of hyperopia. Ninety-one percent (148/163) of the control patients
who had greater than 2.5 diopters of hyperopia maintained good motor
alignment 5 years after surgery compared with 29% of the study group
patients. This difference was statistically significant. Of the eight study
patients with less than 2.5 diopters of hyperopia, five developed good
stereopsis compared with one of 14 patients with greater hyperopia.
CONCLUSIONS: Surgical overcorrection in patients with partly accommodative
esotropia with greater than 2.5 diopters of hyperopia may not be reversible
by postoperative reduction in the hyperopic correction. It often is
reversible, however, in patients with 2.5 diopters or less of hyperopia.
