[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.211.41.181. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Article
December 1995

Partly Accommodative EsotropiaShould You Overcorrect and Cut the Plus?

Author Affiliations

From the Department of Ophthalmology and Visual Sciences, University of Wisconsin—Madison.

Arch Ophthalmol. 1995;113(12):1530-1534. doi:10.1001/archopht.1995.01100120060010
Abstract

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.

References
1.
Parks MM. Ocular Motility and Strabismus . Hagerstown, Md: Harper & Row; 1975:99-111.
2.
Dale RT. Fundamentals of Ocular Motility and Strabismus . New York, NY:Grune & Stratton Inc; 1982:199-200.
3.
Von Noorden GK. Binocular Vision and Ocular Mobility . St Louis, Mo: CV Mosby Co; 1985:282-283.
4.
Gobin M.  Should accommodative strabismus be operated on? J Fr Ophthalmol . 1992;15:483-491.
5.
Wright KW, Bruce-Lyle L.  Augmented surgery for esotropia associated with high hypermetropia . J Pediatr Ophthalmol Strabismus . 1993;30:167-170.
6.
Von Noorden GK.  A reassessment of infantile esotropia: XLIV Edward Jackson Memorial Lecture . Am J Ophthalmol . 1988;105:1-10.
7.
Kraft SP, Scott WE.  Surgery for congenital esotropia: an age comparison study . J Pediatr Ophthalmol Strabismus . 1984;21:57-68.
8.
Friedman L, Furberg CD, DeMets DL.  Issues in data analysis . In: Fundamentals of Clinical Trials . St Louis, Mo: Mosby-Year Book Inc; 1989:241-266.
9.
Kushner BJ, Preslan MW, Morton GV.  Treatment of partly accommodative esotropia with a high accommodative convergence-accommodation ratio . Arch Ophthalmol . 1987;105:815-818.Article
10.
Von Noorden GK, Avilla CW.  Nonaccommodative convergence excess . Am J Ophthalmol . 1986;101:70-73.
11.
O'Hara MA, Calhoun JH.  Surgical correction of excess esotropia at near . Am J Ophthalmol . 1990;27:120-123.
12.
Guyton DL.  Discussion: surgical correction of excess esotropia at near . Am J Ophthalmol . 1990;27:124.
13.
West CE, Repka MX.  A comparison of surgical techniques for the treatment of acquired esotropia with increased accommodative convergence/accommodation ratio . J Pediatr Ophthalmol Strabismus . 1994;31:232-237.
14.
Prism Adaptation Study Research Group.  Efficacy of prism adaptation in the surgical management of acquired esotropia . Arch Ophthalmol . 1990;108:1248-1256.Article
15.
Dankner SR, Mash AJ, Jampolsky A.  Intentional surgical overcorrection of acquired esotropia . Arch Ophthalmol . 1978;96:1848-1852.Article
×