Treatment of adults with accommodative esotropia using implantable collamer lenses

To evaluate the efficacy and safety of the implantation of an implantable collamer lens (ICL) for accommodative esotropia in adults.

From May 2011 to May 2012, 3 adults with complete accommodative esotropia underwent ICL implantation with 12 months of follow-up. Inclusion criteria included having an appropriate anterior chamber depth and endothelial cell count, and hyperopia that was not typically responding well to corneal refractive surgery. Preoperative and postoperative visual acuity, refraction, eye position, corneal endothelial cell count, intraocular pressure, anterior chamber depth, and complications (intraoperative and postoperative) were observed.

Cycloplegic refraction changed from 6.04 ± 0.53 preoperatively to 0.41 ± 0.21 postoperatively (t = 38.9, P < .001). Before surgery, the average esotropia at near (without glasses) was 25 prism diopters (range: 20 to 30 prism diopters). After surgery, all patients achieved orthophoria or microesophoria. Postoperative uncorrected visual acuity at distance and near significantly increased (P < .05), best-corrected visual acuity at near did not change significantly (P = .36), and best-corrected visual acuity at distance improved significantly (P = .03). The average decline in corneal endothelium cell density was 10.3% and remained stable during the follow-up period. One patient complained of glare when driving at night after surgery and this phenomenon gradually disappeared after 3 months. No other intraoperative and postoperative complications, such as ICL-related iris depigmentation, atrophy, glaucoma, or cataracts (partial or complete), were observed.

The preliminary results of this small case study demonstrated that the use of ICL implantation to treat accommodative esotropia in adults was effective and safe; however, a larger scale study is necessary.