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December 1995

Partly Accommodative Esotropia: Should 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

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.

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