LASIK and PRK in refractive accommodative esotropia: a retrospective study on 20 adolescent and adult patients

To evaluate the clinical results obtained with excimer laser treatment of fully refractive accommodative esotropia.

Fully refractive accommodative esotropia was corrected in 17 patients with laser in situ keratomileusis (LASIK) and in 3 patients with photorefractive keratectomy (PRK). The mean age of the patients at time of refractive surgery was 18.8 years (range 14 to 24 years). All surgical procedures were performed under local anesthesia. The preoperative and postoperative data were retrospectively analyzed with regards to visual acuity, ocular alignment, and stereopsis.

The mean preoperative deviation without correction was 18.1Delta for near vision and 13.7Delta for distance vision. After refractive surgery the mean postoperative deviation was 4Delta esophoria at near, and 2.5Delta of esophoria at distance: 10 patients (50%) showed esophoria for both distance and near vision, 2 patients (10%) esophoria only for near vision, and 8 patients (40%) orthophoria for both distance and near vision. Emmetropia (-/+1.00 D) was obtained in 97.5% of eyes (39 of 40). The mean correction obtained with excimer laser was +4.62 D(range +2.25 to +7.75, SD 4.52). The preoperative BSCVA was in all eyes greater than or equal to 20/30. There were no significant differences observed between the preoperative and postoperative mean best-corrected visual acuity (p=0.32). There were no complications. The follow-up period lasted a mean of 30.2 months.

The treatment of fully refractive accommodative esotropia with excimer laser was found effective and safe, even in young or adolescent patients. More studies are needed to increase the patient experience and extend the follow-up period in order to evaluate the stability of these results over time.