Abstract
Consecutive esotropia is a common and stereopsis-threatening consequence of surgery for intermittent exotropia. However, too little attention has been paid to the accommodative convergence per accommodation (AC/A) ratio in this condition. We aimed to describe the clinical features of patients who developed consecutive esotropia with a high AC/A following surgery for intermittent exotropia, compared to those with normal AC/A. In this retrospective cohort study, we identified 54 patients with consecutive esotropia who remained esotropic at one month after surgery. Patients were divided into two groups: normal AC/A and high AC/A groups. Clinical features and outcomes were compared between the two groups. Fourteen (25.9%) of the 54 were classified as high AC/A consecutive esotropia. Good preoperative control at near was the only significant preoperative factor associated with the development of high AC/A consecutive esotropia. Bifocal glasses were prescribed for all patients with high AC/A consecutive esotropia, and 11 (78.6%) of them achieved satisfactory alignment at distance and near fixations using bifocals. Patients with high AC/A consecutive esotropia had a significantly more successful alignment (0.9 vs. 13.0 prism diopters, p < 0.001) and better stereopsis (67.9 vs. 670.0 arc seconds, p = 0.04) than the normal AC/A counterparts at the final follow-up. We suggest that high AC/A consecutive esotropia could be successfully managed by wearing bifocals in most cases. A high AC/A ratio in patients with consecutive esotropia may be considered as a clinical marker heralding a better prognosis.
Highlights
The difference in distance and near deviation has long been of interest in characterizing the phenotypic spectrum of intermittent exotropia [1,2]
Kushner has found that most patients with intermittent exotropia with a high AC/A ratio develop consecutive esotropia after exotropia surgery if the surgery is performed based on distance deviation [5]
Patients with a shorter than 12 months of postoperative follow-up were excluded. Among these patients included in this study, we further identified a group of patients who developed consecutive esotropia following bilateral lateral rectus (BLR) recession
Summary
The difference in distance and near deviation has long been of interest in characterizing the phenotypic spectrum of intermittent exotropia [1,2]. A group of patients with intermittent exotropia may have smaller exodeviation at near than at distance by 10 prism diopters (PD) or more, even after performing the prolonged monocular occlusion test; this type of exotropia is called true divergence-excess exotropia. It is well accepted that a significant proportion of patients with true divergence-excess exotropia may have a high accommodative convergence/accommodation (AC/A) ratio [1,3]. Kushner has found that most patients with intermittent exotropia with a high AC/A ratio develop consecutive esotropia after exotropia surgery if the surgery is performed based on distance deviation [5]. Consecutive esotropia occurs in up to 20% of patients following surgery for IXT
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