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

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Pediatric Ophthalmology

Background:

• Medial rectus (MR) recession is a standard treatment for partially accommodative esotropia (PAET).
• Undercorrection is a frequent complication following standard MR recession in PAET patients.

Purpose of the Study:

• To evaluate the motor and sensory outcomes of augmented MR recession in patients diagnosed with PAET.
• To assess the efficacy of an augmented surgical approach in managing partially accommodative esotropia.

Main Methods:

• An interventional case series was conducted involving patients with PAET.
• Patients underwent augmented bilateral MR recession, with surgical targets based on average distance esotropia (with and without hyperopic correction).
• Posterior pulley fixation was utilized in a subset of patients to address distance-near disparity.

Main Results:

• 110 PAET patients (mean age 5±3 years) were included. Preoperative esotropia averaged 42±13Δ (uncorrected) and 25±11Δ (with correction).
• Despite augmented dosing, 30% of patients had residual esotropia (>5Δ) at follow-up. Consecutive exotropia occurred in 8% of patients.
• Posterior pulley fixation reduced distance-near disparity from 12±5Δ to 1±4Δ. Reoperation was needed in only 7% of cases.

Conclusions:

• Augmented bimedial rectus recession for PAET yields favorable motor and sensory outcomes.
• A significant portion (30%) of patients experienced residual esotropia, indicating augmented dosing may still be insufficient.
• Overcorrections were rare and managed effectively with reduced hyperopic spectacle power.