Augmented-dose surgery on three horizontal muscles for acute acquired comitant esotropia with large deviation

To evaluate the surgical outcomes of augmented-dose surgery using a three-horizontal-muscle approach to treat acute acquired comitant esotropia (AACE) with large deviation.

The medical records of AACE patients with a mean distance and near deviation ≥55^Δ who underwent one-stage three-horizontal-muscle augmented-dose surgery were reviewed. The surgical target angle was augmented by an additional 10^Δ over the average of the near and distance deviations. Primary outcomes included surgical success rate and sensory success rate. Secondary outcomes included duction limitation and lateral incomitance. Surgical success was defined as the elimination of diplopia and deviations ≤10^Δ, assessed with the prism and alternate cover test at both near and distance. Sensory success was defined as stereoacuity ≤600 arcsec.

Twenty-one patients were included. The mean preoperative distance deviation was 69.00^Δ ± 9.72^Δ. The mean postoperative follow-up period was 10.67 months (range, 2-39). At the last postoperative visit, the mean distance deviation was 1.48^Δ ± 2.23^Δ; the surgical success rate was 95.2%; the sensory success rate was 90.5%; no patient showed significant limitation of eye movement or lateral incomitance.

The augmented-dose surgery on three horizontal muscles achieved favorable outcomes in our small cohort of patients with AACE with large deviation, without inducing significant secondary eye movement limitation or lateral incomitance.