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Surgery for esotropia with a high accommodative convergence/accommodation ratio: effects on accommodative vergence
1Department of Ophthalmology and Visual Sciences, St. Louis Children's Hospital at Washington University School of Medicine, St. Louis, MO, USA.
Ophthalmic Surgery and Lasers
|May 1, 1996
Summary
Strabismus surgery effectively treats high accommodative convergence/accommodation (AC/A) ratio esotropia in children, reducing eye deviation and improving binocularity. This surgical approach offers a successful alternative to long-term bifocal use.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Management
Background:
- High accommodative convergence/accommodation (AC/A) ratio esotropia presents a challenge in pediatric eye care.
- Nonrefractive accommodative esotropia often requires long-term management strategies.
Purpose of the Study:
- To evaluate the efficacy of strabismus surgery as an alternative treatment for high AC/A ratio esotropia.
- To compare surgical outcomes with traditional management, such as bifocals.
Main Methods:
- A prospective study included 23 children with AC/A ratio ≥ 5:1 and distance-near disparity ≥ 10 PD.
- Bilateral medial rectus recession was performed to correct near esotropia.
- Measurements included esotropia magnitude, AC/A ratio, and binocularity grade pre- and post-surgery.
Main Results:
- Surgery significantly reduced mean esotropia at near fixation (37 PD to 9 PD).
- 96% of patients no longer required bifocals post-surgery.
- Binocular fusion and stereopsis improved in 70% of patients.
Conclusions:
- Strabismus surgery is a highly effective alternative to long-term bifocal use for high AC/A ratio esotropia.
- Surgical intervention may offer superior outcomes in restoring stereopsis and binocular fusion compared to bifocals.