Objective To evaluate the effect of hyperopic corneal refractive surgery on ocular alignment and stereopsis in patients with accommodative esotropia and amblyopia.
methods: This is a Prospective, noncomparative, interventional case series study From September 2010 to September 2011, 20 eyes of 10 patients with accommodative esotropia were enrolled in this study. Amblyopia was not excluded. All patients received bilateral hyperopic corneal refractive surgery, 7 patients underwent laser in situ keratomileusis (LASIK), and the other 3 patients underwent laser epithelial keratomileusis (LASEK).Best-corrected and uncorrected visual acuity (BCVA and UCVA), refractive error, ocular alignment, and stereopsis were recorded before and after surgery.
Results Mean patient age was 24.0 years (range, 15–35 years), 13 eyes of 9 patients with amblyopia, and 2 patients combined with monocular dissociated vertical deviation (DVD). Mean preoperative cycloplegic refraction (spherical equivalent, SE) was +5.72 diopters (D) for right eyes [range, +2.75 to +8.5 D, standard deviation (SD) 1.69] and+5.47 D for left eyes (range, +2.5 to +8.75 D, SD 1.99) after surgery, mean SE was +1.05 D for right eyes (range, -0.25 to+2.75 D, SD 0.95) and +1.35 D for left eyes (range 0 to+4.5 D, SD 1.48). The mean uncorrected esotropia was significantly reduced from 37.8 prism diopters (PD) (SD 11.4) before surgery to 5.8 PD (SD 6.9) after surgery (P< 0.001). The 8 patients without DVD all converted from esotropia to orthophoric or esophoria. The 2 patients with combined DVD also improved, but there was still residual esotropia and vertical deviation. Using a synoptophore, 2 patients (20%) had stereopsis preoperatively and 9 patients (90%) had stereopsis postoperatively. No patient had lower stereopsis postoperatively. The difference in stereopsis pre- and postoperatively was statistically significant (Wilcoxon signed-rank test, z=2.56， P=0.01）.
Conclusions This prospective study confirmed the effectiveness and safety of corneal refractive surgery not only for accommodative esotropia, but also for patients with amblyopia and even severe anisometropia amblyopia. The surgery can improve UCVA and alignment, as well as improve binocular visual function. |
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