American Orthoptic Journal Abstract
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Volume 49, 1999, p. 77–87
Treatment of Excess Accommodative Convergence (High Gradient AC/A Esotropia) with Medial Rectus Fadenoperation (Abstract)
Edward G. Buckley, M.D.
Objective:
The surgical management of esotropia which is significantly greater at near than distance (high AC/A ratio) presents a therapeutic challenge. In those patients who have an excess convergence secondary to accommodation (high gradient AC/A ratio), a procedure which effectively returns the AC/A ratio to normal would be advantageous. The medial rectus fadenoperation, which theoretically should have a greater effect at near would seem to be ideal for this purpose. We evaluated the effectiveness of this operation on reducing the near/distance disparity and AC/A ratio in this patient population.
Methods:
We reviewed 28 consecutive patients who had bilateral medial rectus recessions combined with a fadenoperation for high AC/A esotropia as determined by the gradient method. Ocular motility and sensory evaluations were performed pre and postoperatively. All patients were followed for at least two years.
Results:
The preoperative mean distance deviation, near deviation, near/distance disparity, and AC/A ratio were 25PD, 47PD, 27A and 8.7, respectively. Postoperatively the mean distance deviation was 2PD, the near deviation was 7PD, the near/distance disparity was 5PD and the mean AC/A ratio was 2.4. Eighty-two percent (23/28) had a manifest deviation less than 10PD at distance and near. The average follow up was 36 months (range 24-64). Stereopsis of greater than 400 arc seconds was present in 27% of patients preoperatively and 64 percent postoperatively. Eighty-nine percent of patients were able to maintain adequate near alignment without bifocals.
Conclusions:
The fadenoperation appears to be successful in normalizing the abnormal near response in patients with a high gradient AC/A ratio esotropia.
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