
Fifteen-Year Outcome of Surgery for the Near Angle in Patients With Accommodative Esotropia and a High Accommodative Convergence to Accommodation Ratio
Burton J. Kushner, MD
Arch Ophthalmol. 2001;119:1150-1153.
Objective To determine the 15-year outcome of patients with partly accommodative
esotropia with a high accommodative convergence to accommodation (AC/A) ratio
who underwent surgery based on the angle of esotropia at one-third meter while
wearing full hyperopic correction.
Methods A retrospective chart review to determine the 15-year outcome of 25
patients whose 6-month outcome had been previously reported as part of a prospective,
randomized, masked clinical trial. All patients had partly accommodative esotropia
with a high AC/A ratio and underwent surgery based on their esotropia at one-third
meter while wearing full-distance optical correction.
Results Fifteen years after surgery, 19 of the 22 patients for whom follow-up
data are available had between 0 and less than 10 prism diopters of esotropia.
Only 6 of the 19 needed to continue to wear optical correction to maintain
satisfactory alignment; however, 8 more needed spectacles for visual purposes.
Only 1 patient needed to use a bifocal add to have satisfactory alignment
at one-third meter. All patients showed some degree of sensory fusion, with
4 obtaining 40 seconds of stereopsis and another 8 obtaining between 60 and
200 seconds of stereopsis.
Conclusion Surgery for the near angle obtained with patients wearing their full
hyperopic distance correction provides excellent motor and sensory results
in patients with partly accommodative esotropia with a high AC/A ratio.
From the Department of Ophthalmology and Visual Sciences, University
of Wisconsin, Madison.
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