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Long-Term Surgical Outcome of Partially Accommodative Esotropia

Correspondence: Requests for reprints should be addressed to: Kyle Arnoldi, C.O., C.O.M.T., St. Louis Children’s Hospital Eye Center, (Room 2 South 89), One Children’s Place, St. Louis, MO 63110. e-mail: arnoldi{at}vision.wustl.edu

Partially accommodative esotropia is an acquired strabismus characterized by high hyperopia, a normal AC/A ratio, and a deviation that responds only partially to spectacle correction. Surgery is done for the non-accommodative portion of the deviation. Over-corrections are managed by reducing the hyperopic power of the spectacles. This retrospective study was done to determine the risk factors for a poor surgical outcome, and to evaluate the efficacy of hyperopic spectacle reduction in the long-term management of consecutive exotropia.

Of the 108 patients enrolled, 19% had a residual esotropia, 37% were surgical successes, and 44% developed consecutive exotropia. Residual ET was associated with deteriorated refractive esotropia, moderate to severe amblyopia, and increasing hyperopia with age. Consecutive XT was associated with a distance-near disparity, low hyperopic refractive error, anisometropia, poor binocular vision, and undercorrection of the hyperopic refractive error prior to surgery. Intentional reduction of the hyperopic correction was not successful in the long-term management of consecutive XT. Fifty-eight percent of those managed in this manner developed a pseudo-dissociated horizontal deviation. The high rate of consecutive exotropia following standard surgery suggests that augmented surgery for partially accommodative esotropia is highly likely to result in over-correction.

Key words: accommodative esotropia, consecutive exotropia, dissociated horizontal deviation