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April 1988

Treatment of Partly Accommodative Esotropia With a High Accommodative Convergence-Accommodation Ratio

Author Affiliations

Freiburg West Germany

Arch Ophthalmol. 1988;106(4):447. doi:10.1001/archopht.1988.01060130489006

To the Editor.  —In the June 1987 issue of the Archives, the results were published of a study by Kushner et al1 on the treatment of accommodative convergence excess, with bilateral medial rectus recessions or recessions with 14-mm posterior fixation sutures. Posterior fixation surgery was considered an unsatisfactory technique in this study, a conclusion based mainly on the frequent occurrence of overcorrections, although large undercorrections also occurred in the recession with posterior fixation suture group. Mims,2 in a letter to the editor in the September 1987 issue of the Archives, reached a similar conclusion: six overcorrections in a group of 30 patients.We think that at least some of these overcorrections were caused by adding a large, uniform-dose posterior fixation operation to a recession that, by itself, was appropriate for the angle measured at distance fixation. It must be realized that posterior fixation surgery not only reduces the

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