AUGMENTED SURGERY FOR ESOTROPIA ASSOCIATED WITH HIGH HYPERMETROPIA

Historically, surgical formulas for the management of accommodative es otropia have been based on the residual deviation with full hypermetro pic correction. This ''standard surgery'' has resulted in a high incid ence of undercorrection. In response to the large number of undercorre ctions with standard surgery, the authors have devised a formula for a ugmenting the amount of rectus recession based on the average of the n ear deviation with and without correction. In this study, we compare a ugmented surgery to standard surgery in patients who underwent bilater al medial rectus recessions for residual esotropia after prescribing f ull hypermetropic spectacle correction. Seventy patients with acquired esotropia after 6 months of age, and hypermetropia of +3.00 or more, were retrospectively studied. Thirty of these patients had undergone s tandard surgery, while 40 had augmented surgery. The follow up on each group was at least 1 year. Of the 30 patients in the nonaugmented gro up, 22 (74%) had postoperative deviations of 10 prism diopters or less with 8 (26%) showing a significant undercorrection. Of the 40 patient s who received augmented surgery, 35 (88%) had postoperative deviation s of 10 DELTA or less and 5 (12%) were exotropic while wearing full hy permetropic correction. Of the 5 patients with a consecutive exodeviat ion while wearing full hypermetropic correction, 2 corrected to orthot ropia by reducing the spectacle correction by +1.50 diopters and +1.25 D (93% success), 2 were converted to orthotropia by removing +3.00 sp ectacle correction (97% success), and 1 continued to have an intermitt ent exodeviation even after removing spectacle correction. This brough t the overall success rate for augmented surgery to 98%. Fusion result s, as measured by Worth Four Dot (W4D) or Titmus Stereo Acuity, showed 10 of the 30 patients with standard surgery (33%) achieved at least p eripheral fusion, whereas 26 of 40 (65%) in the augmented group had po stoperative fusion. Our conclusion is that augmented surgery provides better postoperative alignment and fusion than standard surgery. We re commend surgical recessions based on the average of the near deviation with correction and near deviation without correction.