SURGICAL-TREATMENT OF PARTLY ACCOMMODATIV E ESOTROPIA WITH AND WITHOUT CONVERGENCE EXCESS

Background Partly accommodative esotropia typically shows a persistent convergent angle after correction of hypermetropia. This condition ca n - or cannot - be accompanied by an accommodative convergence excess. Patients and Methods Fifty patients were examined, operated on and fo llowed up by the same team, and were separated into 2 groups: Group 1: partly accommodative esotropia without convergence excess (N=20); Gro up 2: partly accommodative esotropia with convergence excess (N=30). T he operations of the first group consisted of 11 posterior fixations ( Fadenoperations) on both internal recti (IR), and 9 combined horizonta l operations or recessions of both IR. The operations of group 2 consi sted of 23 Fadenoperations and 7 classic procedures. Results Compariso n of angle reductions after a 6-month follow-up showed that posterior fixation was more effective in reducing esotropia when measured withou t glasses (p=0.003), whereas both techniques produced similar effects when angles were considered with correction of hypermetropia. In group 2, the effects of posterior fixation on residual angles at near were significantly higher than on angles measured at distance fixation (p<0 .001). Objective refraction (median) was S + 3.60 for group 1 and S 1.75 for group 2. Conclusion Fadenoperation appeared to satisfactorily reduce convergence excess in our group of 30 patients with partly acc ommodative esotropia. In our series of 20 patients with accommodative strabismus without convergence excess, Fadenoperation was more effecti ve only when angles were considered without glasses.