[Surgical treatment of accommodative esotropia]

Since Donders 1862 the treatment of accommodative esotropia is optical: without an hypermetropic correction, the accommodation needed for vision at distance induces a convergence and an accommodative convergence excess at near. But since 130 years, new clinical and physiological research enables us to propose in specific cases a surgical treatment as an alternative to optical treatment. One of the clinical arguments is the low incidence of strabismus in hypermetropic patients: they can see clear at near and at distance without squinting. One of the physiological arguments is the research by J. Semmlow concerning the near triad: his model demonstrates that the system of accommodation and vergence are interconnected: the accommodative system participates to vergence but also the vergence system participates to accommodation, this is less known. The indications, the technique and surgical treatment are exposed. The analysis of the results by G. Gauthier and J.L. Vercher of the "Laboratoire de Contrôles Sensorimoteurs" at Marseille of the measures of the AC/A ratio confirms the model of Semmlow. The vertical syndrome observed in the accommodative squint is supposed to be the most frequent cause of putting the loop of the vergence system open.