Fifteen-year outcome of surgery for the near angle in patients with accommodative esotropia and a high accommodative convergence to accommodation ratio.

Abstract

To determine the 15-year outcome of patients with partly accommodative esotropia with a high accommodative convergence to accommodation (AC/A) ratio who underwent surgery based on the angle of esotropia at one-third meter while wearing full hyperopic correction. A retrospective chart review to determine the 15-year outcome of 25 patients whose 6-month outcome had been previously reported as part of a prospective, randomized, masked clinical trial. All patients had partly accommodative esotropia with a high AC/A ratio and underwent surgery based on their esotropia at one-third meter while wearing full-distance optical correction. Fifteen years after surgery, 19 of the 22 patients for whom follow-up data are available had between 0 and less than 10 prism diopters of esotropia. Only 6 of the 19 needed to continue to wear optical correction to maintain satisfactory alignment; however, 8 more needed spectacles for visual purposes. Only 1 patient needed to use a bifocal add to have satisfactory alignment at one-third meter. All patients showed some degree of sensory fusion, with 4 obtaining 40 seconds of stereopsis and another 8 obtaining between 60 and 200 seconds of stereopsis. Surgery for the near angle obtained with patients wearing their full hyperopic distance correction provides excellent motor and sensory results in patients with partly accommodative esotropia with a high AC/A ratio.