Changes in Hypermetropic Spectacle Correction after Surgery in Partially Accommodative Esotropia

Sin Woo Bae; Moses Kim; Mi Young Choi

doi:10.3341/jkos.2014.55.5.719

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Bae, Kim, and Choi: Changes in Hypermetropic Spectacle Correction after Surgery in Partially Accommodative Esotropia

Original Article

J Korean Ophthalmol Soc 201;55(5):719-725.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.5.719

Changes in Hypermetropic Spectacle Correction after Surgery in Partially Accommodative Esotropia

Sin Woo Bae, MD, Moses Kim, MD, Mi Young Choi, MD, PhD

Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea

Address reprint requests to Mi Young Choi, MD, PhD Department of Ophthalmology, Chungbuk National University Hospital, #776 1sunhwan-ro, Heungdeok-gu, Cheongju 361-763, Korea, Tel: 82-43-269-6333, Fax: 82-43-264-5263 E-mail: mychoi@chungbuk.ac.kr

Received 23 December 2013 Revised 7 February 2014 Accepted 24 April 2014

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 investigate the characteristics of successfully weaning patients off of glasses and the change in hypermetropic spectacle correction required for maintaining orthotropia using an analysis of surgery results of patients with partially accommodative esotropia.

Methods

We reviewed the medical records of 104 patients who underwent standard surgery for correcting partially accommodative esotropia. In total, 64 patients who had follow-up periods of at least 2 years were included. The patients were divided into 2 groups: 28 patients who were asked to discontinue their hyperopic glasses (glasses-discontinued group) and 36 patients who still needed hyperopic glasses (glasses-maintained group). We investigated the age at first visit and at surgery, total angle of deviation and residual angle of deviation with correction before surgery, weaning time of hyperopic glasses, follow-up period, and the time at which the hyperopic glasses were discontinued in the glasses-discontinued group.

Results

There were no statistically significant differences in the age at first visit and at surgery as well as the duration of postoperative follow-up between both groups. The total esodeviated angle without hyperopic correction of the glasses-discontinued group was significantly lower than that of glasses-maintained group (37.4PD:46.7PD, p < 0.05); there were no significant differences in the remaining esotropic angle after hyperopic correction. The average hyperopic degree in the glasses-discontinued group was significantly lower than that in the glasses-maintained group (+3.0D:+4.7D, p < 0.05), there were no significant differences in the weaning time of hyperopic glasses between both groups.

Conclusions

The esodeviated angle without hyperopic correction was smaller and hyperopic degree was lower in the glasses-discontinued group than in the glasses-maintained group after surgery for partially accommodative esotropia. Therefore, it might be helpful to predict the postoperative possibility to discontinue glasses in the patients with partially accommodative esotropia.

Keywords: Hypermetropia, Partially accommodative esotropia, Spectacles

References

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Table 1.

The clinical characteristics of patients with partially accommodative esotropia

	Glasses-discontinued (n = 28)	Glasses-maintained (n = 36)	p-value
Male:Female	12:16	14:22	0.74^*
Age at diagnosis (years)	3.5 ± 1.9 (range, 0.4 to 11)	3.5 ± 2.6 (range, 0.3 to 14)	0.99^†
Age at surgery (years)	5.2 ± 2.7 (range, 1.5 to 15)	5.1 ± 2.8 (range, 0.9 to 14.5)	0.90^†
Spherical equivalent (diopter)	3.02 ± 1.25	4.72 ± 2.30	<0.001^†
Amblyopia treatment (n, %)	6 (21.4)	12 (33.3)	0.29^*
Inferior oblique overaction (n, %)	3 (10.7)	10 (27.8)	0.09^*
Dissociated vertical deviation (n, %)	1 (3.6)	1 (2.8)	0.85^*
Angle of deviation (PD)
With correction	23.39 ± 7.09	26.67 ± 8.13	0.09^†
Without correction	37.41 ± 9.12	46.73 ± 14.22	0.002^†
Follow-up (months)	75.8 ± 33.9 (range, 24 to 141)	62.8 ± 22.2 (range 24 to 106)	0.36^†

Values are presented as mean ± SD.

PD = prism diopter.

^* Chi-square test;

^† Student t-test.

Table 2.

The ocular position at final follow-up

Ocular position	Glasses-discontinued (n = 28)	Glasses-maintained (n = 36)
Success	23	28
Overcorrection	5	1
Undercorrection	0	7

Table 3.

The distribution of spherical equivalent

Spherical equivalent (diopter)	Glasses-discontinued		Glasses-maintained
Spherical equivalent (diopter)	Initial visit	Final visit	Initial visit	Final visit
≤2.00	13	56	6	25
2.25-≤4.00	34	0	32	35
4.25-≤6.00	7	0	15	4
>6.00	2	0	19	8

Table 4.

The postoperative period at the reduction for spherical equivalent of hyperopic glasses to maintain orthotropia

Postoperative period (months)	Glasses-discontinued (n = 28)	Glasses-maintained(n = 321^*)
≤6	12	5
6-≤12	2	4
12-≤24	7	14
24-≤36	3	2
36-≤48	1	1
48-≤60	3	1
60-≤72	0	2
>72	0	3

^* 4 of 36 patients who were included in glasses-maintained group could not reduce spherical equivalent of glasses.

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