Comparison of Outcomes According to Surgical Method in Partially Accommodative Esotropia in Patients Over 4 Years of Age

Won Seo Ji; Yeon Lee Joo; Jung Paik Hae

doi:10.3341/jkos.2013.54.7.1074

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Ji, Joo, and Hae: Comparison of Outcomes According to Surgical Method in Partially Accommodative Esotropia in Patients Over 4 Years of Age

Original Article

J Korean Ophthalmol Soc 2013;54(7):1074-1078.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.7.1074

Comparison of Outcomes According to Surgical Method in Partially Accommodative Esotropia in Patients Over 4 Years of Age

Won Seo Ji, MD¹, Yeon Lee Joo, MD, PhD², Jung Paik Hae, MD, PhD¹

¹Department of Ophthalmology, Gachon University Gil Medical Center¹, Incheon, Korea

²Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine², Anyang, Korea

Address reprint requests to Hae Jung Paik, MD, PhD Department of Ophthalmology, Gachon University Gil Medical Center, #21 774beon-gil, Namdong-daero, Namdong-gu, Incheon 405-760, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358 E-mail: hjpaik@gilhospital.com

* This study was presented as a narration at the 106th Annual Meeting of the Korean Ophthalmology Society 2011.

Received 27 July 201218 February 2013 Accepted 4 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare postoperative outcomes according to surgical method in partially accommodative esotropia in pa-tients over 4 years of age.

Methods

We compared motor and sensory outcomes between conventional and augmented surgery in 66 patients. The postoperative follow-up period was at least 24 months. The formula for the amount of the rectus muscle recession was based on the distant angle deviation after hyperopic correction in the conventional group and the average amounts of the distant angle deviation with and without full correction of hyperopia in the augmented group. In addition, the conventional group was divided into 2 sub-groups to compare surgical outcomes. The A group consisted of patients who underwent sur-gery with the amount of surgical correction based on distant angle deviation after full hyperopic correction. The B group consisted of patients under the same condition after reduced hyperopic correction to achieve best corrected visual acuity (BCVA).

Results

Among the patients who had an ocular alignment less than 10 PD, orthophoria was significantly higher in the con-ventional group than in the augmented group on the last follow-up. When comparing the 2 conventional sub-groups, the postoperative stereoacuity was better in group B than in group A. Among patients with a postoperative overcorrected align-ment of more than 10 PD who underwent augmented surgery, 75% showed decreased postoperative stereoacuity com-pared to preoperative stereoacuity.

Conclusions

In partially accommodative esotropia in patients over 4 years of age, conventional surgery compared to aug-mented surgery after reduced hyperopic correction is better in order to achieve BCVA for postoperative stereoacuity as well as ocular alignment.

Keywords: Augmented surgery, Conventional surgery, Partially accommodative esotropia, Stereoacuity, Surgical outcome

References

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Table 1.

Baseline characteristics of conventional and augmented groups in partially accommodative esotropia

Characteristic	Conventional group^*	Augmented group^†	p-value
Number of patients	24	42
Age at operation (years)	5.79 ± 2.45	5.83 ± 1.85	0.401^‡
Follow up (months)	63.04 ± 25.2	65.40 ± 27.22	0.100^‡
Preoperative refractive error (Dsph)	+3.76 ± 1.94	+3.64 ± 2.00	0.110^‡
Preoperative alignment
Without glasses (PD)	52.08 ± 18.99	50.59 ± 9.39	0.442^‡
With glasses (PD)	27.79 ± 7.17	28.78 ± 5.40	0.398^‡

Values are presented as mean ± SD. SD = standard deviation; Dsph = diopters as spherical equivalent; PD = prism diopters.

^* Patients who underwent conventional surgery

^† Patients who underwent augmented surgery

^‡ Mann-Whitney U test.

Table 2.

Postoperative alignment of conventional and augmented groups

Ocular alignment	Conventional group	Augmented group	p-value
Under corrected (ET > 10 PD)	33.3% (8/24)	14.3% (6/42)	0.019^*
Corrected (Ortho ± 10 PD)	62.5% (15/24)	57.1% (24/42)	0.022^*
Over corrected (XT > 10 PD)	4.1% (1/24)	28.6% (12/42)	0.014^*

PD = prism diopters; ET = esotropia; Ortho = orthophoria; XT = exotropia.

^* Fisher's exact test.

Table 3.

Baseline characteristics of group A and B in conventional surgery

Characteristic	A group^*	B group^†	p-value
Number of patients	12	12
Age at operation (years)	4.50 ± 1.17	7.08 ± 2.75	0.020^‡
Preoperative refractive error (Diopters)	+3.67 ± 1.50	+3.86 ± 2.37	0.876^‡
Amount of surgical correction (PD)	27.50 ± 8.66	30.42 ± 8.38	0.401^‡
Preoperative alignment
Without glasses (PD)	55.0 ± 24.21	49.17 ± 12.22	0.607^‡
With glasses (PD)	26.67 ± 5.37	28.91 ± 8.71	0.342^‡

Values are presented as mean ± SD. SD = standard deviation; Dsph = diopters as spherical equivalent; PD = prism diopters.

^* Patients underwent a surgery with amount of surgical correction based on distant angle deviation after full hyperopic correction

^† Patients underwent a surgery with amount of surgical correction based on distant angle deviation after reduced hyperopic correction to get best corrected visual acuity

^‡ Mann-Whitney U test.

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