Photorefractive keratectomy followed by strabismus surgery for the treatment of partly accommodative esotropia (original) (raw)
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American Journal of Ophthalmology, 2018
Accommodative esotropia is a common cause of acquired esotropia. Pathogenesis varies among patients but usually includes excessive hyperopia and a high accommodative convergence/accommodation ratio or tight medial recti. The present study reviews an individualized treatment plan combining photorefractive keratectomy (PRK) and strabismus surgery to correct these problems. Design: This study is a retrospective, interventional case series. Methods: Records for 15 patients who were treated for accommodative esotropia were reviewed. Patient ages ranged from 11 to 19 years. PRK and strabismus surgery were performed on 11 patients, and PRK only on 4 patients. The goal was to create a physiologic refractive error, good visual acuity (VA), and straight eyes without correction. Results: All patients were spectacle free at 6-month follow-up. Twenty-four of 30 eyes had VA equal to preoperative VA without correction. Three eyes had a 1 line reduction and 2 line reduction in VA. The alignment results were ±10 prism diopters in 13/15 patients. Spherical refractive outcomes were 18/30 eyes within 1 diopter (D) of target and 12/30 eyes within 2 D of target. Astigmatism refractive outcomes were 21/30 eyes <1 D, 7 eyes 1-2 D, and 2 eyes >2 D. Two patients complained of halos at night, and one patient had peripheral corneal haze. Conclusion: Simultaneous PRK and strabismus surgery is safe and effective in treating accommodative esotropia. An individualized treatment plan can result in a physiologic refractive error, good VA, and a spectacle-free existence.
Refractive Surgery for Accommodative Esotropia: Past, Present, and Future
European Journal of Ophthalmology, 2012
Introduction. Refractive surgery has the potential to be a definitive treatment for accommodative esotropia, yet it has not been widely embraced. This article reviews the current literature on refractive surgery to treat accommodative esotropia. Methods. A literature search was performed using the following terms: refractive surgery, photorefractive keratectomy, laser-assisted keratomileusis, intraocular lens, hyperopia, accommodative esotropia, children, pediatric. Results. Fifteen series of patients treated with refractive surgery for accommodative esotropia were identified and summarized. Conclusions. Refractive surgery holds promise for the treatment of accommodative esotropia, although treatment risks are present and additional investigation is needed.
Refractive Surgery for Accommodative Esotropia: 5-Year Follow-up
Journal of Refractive Surgery, 2014
IntroductIon. Refractive surgery has the potential to be a definitive treatment for accommodative esotropia, yet it has not been widely embraced. This article reviews the current literature on refractive surgery to treat accommodative esotropia. Methods. A literature search was performed using the following terms: refractive surgery, photorefractive keratectomy, laser-assisted keratomileusis, intraocular lens, hyperopia, accommodative esotropia, children, pediatric. results. Fifteen series of patients treated with refractive surgery for accommodative esotropia were identified and summarized. conclusIons. Refractive surgery holds promise for the treatment of accommodative esotropia, although treatment risks are present and additional investigation is needed.
Journal of Cataract and Refractive Surgery, 2009
METHODS: This prospective study comprised patients with hyperopia and purely accommodative hyperopic esotropia. A complete ophthalmologic examination was performed preoperatively and 1, 3, and 12 months postoperatively. The examination included uncorrected (UDVA) and corrected (CDVA) distance visual acuities and orthoptic and sensory tests. All patients also had keratometry, pachymetry, and corneal topography assessment before and after treatment. Treatment was performed using a Technolas 217 excimer laser. RESULTS: Thirty eyes of 15 patients (mean age 30.8 years) were treated. Preoperatively, the CDVA was 20/30 or better in all eyes and the mean cycloplegic spherical equivalent (SE) was C3.50 diopters (D). One year postoperatively, the UDVA was 20/30 or better in all eyes and the mean SE was À0.01 D. The mean esotropic deviation for distance vision without correction preoperatively was 8.7 prism diopters. At 1 year of follow-up, 12 patients achieved orthophoria and 3 patients had a reduction in the angle of deviation. There were no intraoperative or postoperative complications. Stereopsis was unaffected by treatment in all patients. CONCLUSIONS: Photorefractive keratectomy was effective in the treatment of purely accommodative esotropia in young adult patients at a follow-up of 1 year. There were no cases of visual acuity loss or complications from the laser treatment.
International ophthalmology, 2018
To evaluate refractive, binocular vision and ocular alignment outcomes of photorefractive keratectomy (PRK) for the treatment of hyperopia in esotropic patients. Medical charts of hyperopic patients with full or partial accommodative esotropia (FAE or PAE) or consecutive exotropia (CE) undergone PRK from 2011 to 2014 were reviewed. The primary outcome was to assess the efficacy of PRK in improving ocular alignment. The secondary outcomes were the assessments of uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent (SE) and stereoacuity. Sixty-four eyes of 32 hyperopic patients were included. Three patients were affected by FAE, 24 by PAE and 5 by CE. All FAE patients and 4 PAE patients underwent only PRK; the remaining 25 patients underwent PRK plus strabismus surgery. After PRK, the mean corrected esodeviation decreased significantly in the overall esotropic population [7.15 ± 9.42 prism diopters (PD) vs. 5.04 ± 8.83 PD; p = 0.03] and in partic...
Hyperopic corneal refractive surgery in patients with accommodative esotropia and amblyopia: Comment
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015
To explore whether hyperopic excimer corneal refractive surgery can affect ocular alignment and stereopsis in patients with both accommodative esotropia and amblyopia. METHODS 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. RESULTS Preoperative cycloplegic refraction in the right eyes was 15.64 AE 2.09 D; in the left eyes, 15.91 AE 1.97 D. After surgery, refraction in the right eyes was 11.13 AE 1.21 D; in the left eyes, 11.44 AE1.53 D. The mean logMAR uncorrected visual acuity was 0.46 AE 0.30 before surgery and 0.32 AE 0.25 after surgery (t 5 5.72, P 5 0.001). The mean pre-and postoperative best-corrected visual acuity were 0.31 AE 0.28 and 0.29 AE 0.25, respectively; there was no significant difference between the two groups (t 5 1.23, P 5 0.22). The average uncorrected esotropia was 37.92 D AE 9.12 D before surgery and 2.76 D AE 2.80 D 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. CONCLUSIONS In this cohort, hyperopic corneal refractive surgery can improve the alignment, uncorrected visual acuity, and stereopsis in patients with accommodative esotropia and amblyopia.
PLOS ONE, 2018
Accommodative esotropia (AE) is a convergent deviation due to an excess of the convergence linked to the innervational stimulus for accommodation and it is usually associated to the presence of hyperopia. The development of hyperopia over time has been widely described but the lack of comparative analysis among accommodative esotropia subtypes, does not allow to verify the existence of different developmental patterns. In this study we aimed to describe the long term changes of refractive error in patients affected by accommodative esotropia as a function of the strabismus type: refractive (RAE), non-refractive (NRAE) and partially accommodative esotropia (PAE). The medical records of 66 patients (24 RAE, 22 PAE, 20 NRAE), who wore the full correction of their cycloplegic refraction error during the entire follow up period, were retrospectively reviewed. Mean outcome was the analysis of the variations, among groups, of refractive error over time; differences between mild (3.00D) and high (!5.00D) hyperopia, effects of amblyopia and relationship with AC/A ratio were also investigated. All patients were followed up from approximately 4 years of age to 20, with mean follow up of 16.06±0.29 years. Our results described similar non-linear trend of refractive error development among groups. The initial increase of hyperopia (up to 7-8 years) was followed by a decreasing trend persisting up to adulthood (approximately 20 years of age). During this period, spherical equivalent decreased at a lower mean annual rate in patients affected by RAE (-0.07D) compared to other groups (NRAE-0.11D, p = 0.003 and PAE 0.13D, p = 0.002). In all groups, however, significant amount of hyperopia was found at last examination; indeed the observed difference in SE values from baseline to the end of follow up, was not significant (RAE: +0.27D, 95% C.I.-0.49 to +1.04D, p = 0.472; PAE:-0.69D, 95% C.I.-1.67 to +0.28D, p = 0.154; NRAE:-0.39D, 95% C.I.-1.11 to +0.34D, p = 0.278). AC/A ratio, amblyopia and amount of initial hyperopia appeared to have no significant role in longitudinal change of the refractive error. In conclusion, this study provides a complete overview, from childhood to adulthood, of refractive error development in different form of accommodative esotropia.
Surgical Treatment of Esotropia Associated with High Myopia: Unilateral versus Bilateral Surgery
European Journal of Ophthalmology, 2010
PurPose. To compare unilateral versus bilateral surgical treatment of esotropia associated with high myopia. Methods. This retrospective study comprised patients who underwent surgery for esotropia with high myopia performed by the first author (Y.M.) between 2003 and 2008. Surgical results and complications were compared between patients who underwent unilateral versus bilateral surgery. results. Nine patients were identified with average age of 44.9 years (range 8-70 years). All had bilateral high myopia (average-13.35 D, range-9.00 to-17.50 D) and esotropia of 20-75 diopters, together with hypotropia in 5 cases. Bilateral displacement of the lateral rectus inferiorly and superior rectus medially was demonstrated in each patient by computed tomography scan of the orbits and by observation during surgery. Five patients underwent bilateral surgery and 4 underwent unilateral surgery. After an average follow-up of 29 months (range 4-47 months), 4/5 patients who underwent bilateral myopexy achieved good results with postoperative esotropia of less than 8 diopters, as opposed to 2/4 patients who underwent unilateral surgery. No complications were noted. ConClusions. Bilateral superior and lateral rectus myopexy is the preferred method of surgical correction of esotropia associated with high myopia. Additional unilateral or bilateral medial rectus recession is probably not indicated in most cases. Patients who prefer unilateral surgery can benefit from unilateral superior and lateral rectus myopexy together with medial rectus recession. This unilateral approach may yield good results particularly in young patients without markedly restricted and tight extraocular muscles.
Consecutive Exotropia after LASIK in a Patient with Accommodative Esotropia
Journal of Ophthalmic & Vision Research
Purpose: To report consecutive exotropia after hyperopic laser in situ keratomileusis (LASIK) in a patient with accommodative esotropia. Methods: A 22-year-old female patient with hyperopia and mild to moderate amblyopia in her right eye was referred for accommodative esotropia. She had undergone right medial rectus recession 4 years ago. Examination revealed right esotropia of 25 and 6 prism diopters (PD) without and with correction, respectively. She underwent LASIK in both eyes to correct the refractive accommodative esotropia. Eight months after LASIK, her refraction was plano-0.75@160 and +0.5-0.75@180 in the right and left eyes respectively, but she developed right exotropia of 20 PD without correction. Conclusions: Although hyperopic LASIK may be considered as an alternative treatment for refractive accommodative esotropia, the presence of amblyopia and absence of fusion preoperatively increase the risk of postoperative exotropia.