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April 1988

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

Arch Ophthalmol. 1988;106(4):448. doi:10.1001/archopht.1988.01060130489008

In Reply.  —Dr Simonsz' assertion that posterior fixation surgery reduces the angle of strabismic deviation measured at distance fixation led me to reexamine data from 39 of my patients with partly accommodative esotropia with a high accommodative convergence-accommodation ratio, whom I had treated with posterior fixation combined with bilateral medial rectus recessions. For each case I calculated the expected correction from a previously published dose-response curve.1 This dose-response curve was almost identical to the basic formula for bilateral medial rectus recessions cited by Kushner et al. The average additional correction measured at distance fixation obtained for these patients varied from −4 prism diopters (PD) for posterior fixation sutures placed 12 mm posterior to the original insertion of the medial recti to 7 PD for posterior fixation sutures placed 15 mm posterior to the original insertion of the medial recti. These averages are somewhat smaller than those suggested by Dr