Surgical outcomes for esotropia in children with high accommodative convergence/accommodation ratio


To assess whether a high accommodative / accommodative convergence (AC / A) ratio affects surgical outcomes in children with esotropia (ET) and to assess the appropriate target angle of surgical dosing in the presence of a high AC / A ratio. A retrospective review identified patients who suffered a primary bilateral medial rectus (BMR) due to TS. Patients were excluded if the follow-up was ≤ 2 months. Basic demographic information, visual acuity, stereopsy, orientation, and target angles for surgery were collected. High AC / A was defined as a deviation of ≥10 prismatic diopters (Δ)  near compared to distance. Outcome parameters were near and far deviations ≤10Δ within orthophoria and / or postoperative stereopsis. Yates' Continuity Correction, Unpaired T Test, Regression Analysis and one-way ANOVA were used. 103 patients were identified preoperatively, 23 with high AC / A and 80 with normal AC / A. The mean age was 4.0 ± 2.5 years. Surgical success, measured by postoperative orientation, was 48% and 45% in the high AC / A and normal AC / A groups (P = 1.0). There was a statistically significant difference in preoperative close deviation between the high AC / A and normal AC / A groups (P = 0.0015); however, there were no significant differences in preoperative distance deviation (P = 0.061). Furthermore, there were no significant differences in preoperative or postoperative stereopsis between the high AC / A and normal AC / A groups (P = 0.88 and P = 0.44, respectively). There was a significant difference in the normal AC / A and high AC / A groups when the target angle was in the preoperative near deviation as determined by one-way ANOVA (F = 170.88, P <0.0001, and P <0, 0001, respectively). F = 14.61, P = 0.0010). In ET treated with BMR recession, the presence of a high AC / A does not affect surgical success as measured by alignment and stereopsis. Furthermore, at high AC / A values, surgical dosing with a target angle in the direction of a close deviation has been found to provide the best surgical results in our patient population. 

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