Surgical Outcomes in Partially Accommodative Esotropia Using Augmented Distance-Angle Averaging With and Without...

Undercorrection is common after standard dosing of medial rectus (MR) recession for partially accommodative esotropia (PAET). Our goal was to evaluate motor and sensory outcomes in patients with PAET undergoing augmented MR recession.

Interventional case series.

We studied patients with PAET who underwent augmented bilateral MR recession targeted to the average distance esotropia with and without hyperopic correction.

A total of 110 patients (47% female) with a mean age of 5 ± 3 years were included. Preoperative distance esotropia measured 42 ± 13Δ without spectacle correction and 25 ± 11Δ with full hyperopic spectacle correction. Surgery was performed for target angles based on Parks' tables. Despite using an augmented target angles that exceeded the deviations measured with hyperopic correction, 33 patients (30%) had >5Δ residual esotropia at final follow-up. Consecutive exotropia developed in 9 patients (8%), of whom 8 (89%) were managed with hyperopic undercorrection. Posterior pulley fixation in 23 patients reduced the mean distance-near disparity from 12 ± 5Δ to 1 ± 4Δ. Only 8 patients (7%) underwent reoperation, 7 for persistent esotropia and 1 for consecutive exotropia.

Augmented bimedial rectus recession for PAET, based on a target angle averaging distance esotropia with and without correction, achieved high rates of favorable motor and sensory outcomes. Nevertheless, 30% of patients had residual esotropia, underscoring that even augmented dosing may be insufficient. Rare overcorrections were effectively managed by reducing hyperopic spectacle power.