Strabismus Surgical Outcomes in Patients with Tonic and Accommodative Convergence Excess Esotropia

Minwoo Lee; Sueng-Han Han; Jinu Han

doi:10.3341/jkos.2018.59.5.465

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Lee, Han, and Han: Strabismus Surgical Outcomes in Patients with Tonic and Accommodative Convergence Excess Esotropia

Original Article

Journal of the Korean Ophthalmological Society 2018; 59(5): 465-470.

Published online: 17 May 2018

DOI: https://doi.org/10.3341/jkos.2018.59.5.465

Strabismus Surgical Outcomes in Patients with Tonic and Accommodative Convergence Excess Esotropia

Minwoo Lee, MD¹, Sueng-Han Han, MD², Jinu Han, MD¹

¹The Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

²The Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Address reprint requests to Jinu Han, MD. Department of Ophthalmology, Gangnam Severance Hospital, #211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea. Tel: 82-2-2019-2570, Fax: 82-2-312-0541, Jinuhan@yuhs.ac

Received 24 August 2017 Revised 24 December 2017 Accepted 16 April 2018

The Korean Ophthalmological Society

(open-access):

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 surgical outcomes of augmented bilateral medial rectus (BMR) recession in patients with low accommodative convergence/accommodation (AC/A) ratio tonic convergence excess esotropia (ET) compared to high AC/A ratio convergence excess ET.

Methods

This study included patients with esodeviation ≥10 prism diopter at near than at distance fixation who underwent BMR recession. The medical records of all esotropic patients with convergence excess who underwent strabismus surgery were reviewed. Six patients with tonic convergence excess and 10 patients with a high AC/A ratio met the study inclusion criteria. A successful outcome was defined as a near or distance angle of deviation ≤8 prism diopter and a ≤10 prism diopter difference between the two at the final recorded visit.

Results

The mean age at surgery was 5.9 ± 1.6 years in the tonic convergence excess ET group and 7.3 ± 2.9 years in the high AC/A ET group (p = 0.301). The average length of the postoperative follow-up was 2.7 years (range, 0.6–8.4 years) in the tonic convergence excess ET group and 4.0 years (range, 0.6–8.4 years) in the high AC/A ET group (p = 0.426). Near-distance disparities were reduced in all patients with tonic convergence excess ET within 10 prism diopter postoperatively, but in only 6 of 10 patients in the high AC/A ET group. Five of 6 patients (83.3%) had successful outcomes in tonic convergence excess ET group; 5 of 10 patients (50%) had successful outcomes in the high AC/A ET group.

Conclusions

In our series, five patients (83%) obtained successful results in the tonic convergence excess ET group compared with 50% in the high AC/A ET group. Augmented BMR recession can be safely performed in esotropic patients with tonic convergence excess.

Keywords: Convergence excess, Esotropia, Strabismus

Figures and Tables

Table 1

Clinical demographic and pre- and postoperative deviation in patients with non-accommodative tonic convergence excess esotropia and accommodative convergence excess esotropia

D = distance; N = near; BMR Rec = bimedial rectus muscle recession; AC/A = accommodative convergence per accommodation ratio; M = male; F = female; Δ = prism diopter; ET = esotropia; RXT = right exotropia; XT = exotropia.

Table 2

Table for surgery of esotropia (bilateral medial rectus recession)

N = near; PD = prism diopters.

Table 3

Comparison of clinical characteristics and pre- and postoperative data in tonic convergence excess and high AC/A ratio group

Values are presented as mean ± SD (range) or n (%) unless otherwise indicated.

Preop = preoperative; AC/A = accommodative convergence per accommodation; D = distance; PD = prism diopters; N = near; Postop = postoperative.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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