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Nicholas Faron, James Hoekel, Lawrence Tychsen; Refractive Surgery for Accommodative Esotropia in Special Needs Children and Adolescents. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3127.
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Reports of refractive surgery performed to treat esotropia have been limited to small series or case reports. Here we analyze outcomes in a sizeable number of children and adolescents treated using the excimer laser or phakic intraocular lenses.
Clinical outcome data were collated prospectively in 54 children and adolescents (108 eyes) treated for hyperopia using excimer laser keratectomy or implantation of phakic IOLs. All children had esotropia; fully accommodative (21 children) or partially-accommodative/mixed mechanism (33 children) and difficulties with spectacle or contact lens wear. Mean age at refractive surgery was 10.2 yrs (range 3 to 18 years); mean follow-up was 2.9 yrs.
Spherical refractive error averaged 4.86 D (range +2.25 to +6.75) in children treated using excimer laser and +9.25 (range +6.75 to +11.5) in those treated by IOL implantation. 90/108 eyes (83%) were corrected to within +/- 1.0 D of target refractive error and all to within 1.5 D. Best-corrected and uncorrected visual acuity improved 0.12 logMAR and 0.58 logMAR respectively. Pre-operative esotropia averaged 6.1 PD wearing refractive correction and 24.4 D not wearing correction. Esotropia after refractive surgery (not wearing correction) was reduced to an average 8.3 D. During the follow-up period 15% (8 children) required strabismus re-operation.
Excimer laser keratectomy or phakic IOL implantation are unusual but useful treatment alternatives for accommodative esotropia in a subpopulation of special needs strabismic children. Refractive surgery for hyperopia reduces substantially the angle of accommodative esotropia in children who have difficulties with spectacle or contacts lens wear. Longer term follow-up will reveal whether refractive regression promotes recurrence of larger heteroptropia.
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