Outcome of surgery for near angle in patient with incomitant distance/near esotropia and without manifest deviation at distance

Abstract

Introduction:

To investigate how a subset of patients with partially accommodative esotropia, with a manifest deviation <10 Prism Diopters (PD) at distance and an angle of strabismus at near wider than 10 PD, could respond to a surgical approach based on the misalignment at near.

Methods:

Six patients examined from 2015 to 2019 met criteria for inclusion: partially accommodative esotropia, patients compliant to full correction for at least 6 months, angle of esotropia for near larger at least 10 PD, angle of misalignment obtained with the alternate prism cover test and simultaneous prism cover test at distance <10 PD. All patients underwent bilateral medial recti recession. They were examined at 3 weeks and at 6 months.

Results:

No significant difference in the angle of esotropia at distance was found at any follow-up (Baseline: 7.17 ± 1.33 PD vs 3 weeks: 7.0 ± 1.01 PD vs 6 months: 7.33 ± 1.03 PD, p = 0.65, and p = 0.36, respectively). No case of consecutive exotropia was described. Considering the angle at near, there was a significant reduction at 3 weeks (Baseline: 41.7 ± 6.83 PD vs 3 weeks: 9.33 ± 1.63 PD, p = 0.027), that remained stable at the final follow-up (9.0 ± 1.1 PD, p = 0.32). All patients were suppressors and had nil stereopsis pre-operatively, all of them developed fusion and a different degree of stereopsis [276 ± 284 arcseconds (Range 80–800)].

Conclusions:

A surgical approach based on the angle of strabismus for near could obtain satisfactory ocular alignment without consecutive exotropia in children with partially accommodative esotropia wearing full refractive correction, with a manifest deviation for distance <10 PD and a higher misalignment for near, at least for 6 months after surgery.

Keywords

Strabismus eso and exo deviations strabismus surgery/complications heterophoria eye movement disorders

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References

Parks

MM.

Concomitant esodeviations. In: Medical Department, Harper & Row, 1975 (eds) Ocular motility and strabismus. Hagerstown, MD: Medical Department, University of Michigan. Harper & Row; 1975, pp. 99–111.

Rosenbaum

Jampolsky

Scott

AB.

Bimedial recession in high AC/A esotropia. A long-term follow-up. Arch Ophthalmol (Chicago, Ill 1960) 1974; 91(4): 251–253.

Kushner

Morton

Preslan

MW.

Treatment of partly accommodative esotropia with a high accommodative convergence-accommodation ratio. Arch Ophthalmol 1987; 105(6): 815–818.

Kushner

BJ.

Fifteen-year outcome of surgery for the near angle in patients with accommodative esotropia and a high accommodative convergence to accommodation ratio. Arch Ophthalmol (Chicago, Ill 1960) 2001; 119(8): 1150–1153.

Rosenbaum

Santiago

AP.

Clinical strabismus management : principles and surgical techniques. Philadelphia, PA: Saunders; 1999.

Kushner

Fisher

Is alignment within 8 prism diopters of orthotropia a successful outcome for infantile esotropia surgery?

Arch Ophthalmol 1996; 114(2): 176–180.

Kassem

Elhilali

HM.

Factors affecting sensory functions after successful postoperative ocular alignment of acquired esotropia. J AAPOS 2006; 10(2): 112–116.

Kassem

RR.

Factors affecting the motor outcome after corrective surgery for acquired comitant esotropia. Eur J Ophthalmol 2020; 30(1): 132–138.

Hwang

Min

Park

, et al. A randomized comparison of prism adaptation and augmented surgery in the surgical management of esotropia associated with hypermetropia: one-year surgical outcomes. J AAPOS 2001; 5(1): 31–34.

10.

Kassem

Elhilali

El-Sada

, et al. A comparative study of prism adaptation and the augmented surgery formula in the management of acquired comitant esotropia. J Pediatr Ophthalmol Strabismus 2020; 57(2): 108–119.

11.

Leitch

Burke

Strachan

IM.

Convergence excess esotropia treated surgically with fadenoperation and medial rectus muscle recessions. Br J Ophthalmol 1990; 74(5): 278–279.