Hyperopic corneal refractive surgery in patients with accommodative esotropia and amblyopia

Abstract

To explore whether hyperopic excimer corneal refractive surgery can affect ocular alignment and stereopsis in patients with both accommodative esotropia and amblyopia. In this prospective study, 26 eyes of 13 patients with accommodative esotropia and amblyopia underwent bilateral hyperopic corneal refractive surgery: 9 patients underwent laser in situ keratomileusis (LASIK); 4, laser epithelial keratomileusis (LASEK). The main ocular examinations included pre- and postoperative best-corrected and uncorrected visual acuity, refractive error, ocular alignment, and stereopsis. Preoperative cycloplegic refraction in the right eyes was +5.64 ± 2.09 D; in the left eyes, +5.91 ± 1.97 D. After surgery, refraction in the right eyes was +1.13 ± 1.21 D; in the left eyes, +1.44 ±1.53 D. The mean logMAR uncorrected visual acuity was 0.46 ± 0.30 before surgery and 0.32 ± 0.25 after surgery (t = 5.72, P = 0.001). The mean pre- and postoperative best-corrected visual acuity were 0.31 ± 0.28 and 0.29 ± 0.25, respectively; there was no significant difference between the two groups (t = 1.23, P = 0.22). The average uncorrected esotropia was 37.92(Δ) ± 9.12(Δ) before surgery and 2.76(Δ) ± 2.80(Δ) after (P<0.001). Using a synoptophore, 2 patients (15.3%) had preoperative stereopsis and 11 patients (84.6%) had postoperative stereopsis. No patients experienced lower stereopsis postoperatively. In this cohort, hyperopic corneal refractive surgery can improve the alignment, uncorrected visual acuity, and stereopsis in patients with accommodative esotropia and amblyopia.