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

Area of Science:

• Ophthalmology
• Strabismus Surgery
• Pediatric Ophthalmology

Background:

• Acute acquired comitant esotropia (AACE) with large deviations presents a surgical challenge.
• Effective treatment strategies are crucial for restoring binocular vision and reducing diplopia.

Purpose of the Study:

• To evaluate the surgical and sensory outcomes of augmented-dose surgery using a three-horizontal-muscle approach for AACE with large deviations.
• To assess the safety profile, including induced duction limitation and lateral incomitance.

Main Methods:

• Retrospective review of AACE patients with mean deviations ≥55Δ undergoing one-stage augmented-dose surgery.
• Surgical target angle was augmented by an additional 10Δ over the average of near and distance deviations.
• Surgical success defined as deviations ≤10Δ and elimination of diplopia; sensory success defined as stereoacuity ≤600 arcsec.

Main Results:

• Ninety-five percent of patients achieved surgical success, with a mean postoperative distance deviation of 1.48Δ.
• Ninety-one percent achieved sensory success.
• No patients experienced significant limitation of eye movement or lateral incomitance postoperatively.

Conclusions:

• Augmented-dose surgery on three horizontal muscles is a favorable treatment for AACE with large deviations.
• This approach demonstrates high efficacy and safety, with minimal risk of secondary complications.
• Further research in larger cohorts is warranted to confirm these findings.