Comparison of standard and augmented surgical procedures in the management of partial accommodative esotropia

Abstract: The results of standard and augmented surgical treatment of partial accommodative esotropia have been compared in this study.In this sequential matched randomized double blind clinical trial, we studied 48 patients (96 eyes) with partial accommodative esotropia between the ages of 13 to to 144 months, referring to strabismus clinic of Farabi Eye Hospital between 1999-2000. These patients were grouped according to age degree of hyperopia and AC/A ratio and then were randomly divided in two standard and augmented groups (24 patients in each group). All patients were followed for at least 6 months after standard or augmented biomedial recession with or without inferior oblique weakening procedure. Post operative visual acuity, hyperopia, eye deviation, stereopsis, fusion and AC/A ratio were compared between the two groups Post operative acceptable deviation was observed in 37.5% and 87.5% at first week follow up P<0.001). 66.6% and 91.5% at 6 th week of follow up (P<0.05), 91.6% and 95% at 6 th month of follow up (not significant [N.S]) of patients in standard and augmented groups respectively.Other results of standard and augmented groups are as follow:-Improvement of visual acuity (at least one line) in 8.3% and 20.5% (N.S). -Improvement of fusion in 8 out of 13 patients (61.5%) and in 9 of 14 patients (64.3%) (N.S).-Reduction of post operative hyperopia in 3 Patients (12.5%) & 6 patients (25%) (N.S).-Reduction of AC/A ratio in all patients with high AC/A ratio, in both groups.-Improvement of stereopsis in 2 of 13 patients (15.4%) and in 3 of 13 patients (23%) (N.S).this study shows that augmented surgery improves longterm alignment, visual acuity, stereopsis and fusion greater than the standard group, but with statistically insigificant difference, which might be due to short duration of followr up and the small number of cases in each group.