Comparing Park Table - Augmented and Standard Surgical Doses in Acute Acquired Comitant Esotropia: A Retrospective Analysis.

Abstract

Purpose: Acquired comitant esotropia (ACE) is a rare condition characterized by the sudden onset of inward eye deviation. In non-recovered cases, surgery was performed. The standard surgical dose typically leads to undercorrection, and multimodal approaches were used to enhance outcomes. The current study aimed to explore the clinical course and identify factors influencing surgical success in patients with ACE at a tertiary hospital.

Patients and methods: This retrospective study reviewed the electronic medical records of 99 patients diagnosed with ACE at Phramongkutklao Hospital between 2014 and 2024. Data collected included patient demographics, underlying etiologies, clinical presentations, treatment approaches, and surgical outcomes. Surgical cases were categorized based on the use of either the standard Park surgical dosage or an augmented dose, defined as an additional 0.5 mm beyond the standard amount. Factors associated with successful surgical outcomes were also evaluated through statistical analysis.

Results: The mean age at diagnosis was 28.97 ± 19.67 years, with a slight predominance of men. ACE was classified as types I (Swan type), II (Burian-Franceschetti), and III (Bielschowsky) in 8.08% (8/99), 46.46% (46/99), and 45.45% (45/99), respectively. All cases were idiopathic, with neuroimaging abnormalities detected in 4.04% (4/99) of patients. Surgical intervention was required in 79.8% (79/99) of cases. One year postoperatively, 75% (54/72) of patients demonstrated substantial improvement in ocular alignment. Based on subgroup analysis, the success rate was 91.18% in the augmented group and 60.53% in the non-augmented group. Logistic regression analysis indicated that an augmented surgical dose was significantly associated with favorable surgical outcomes (adjusted odds ratio: 5.50; 95% confidence interval [95% CI], 1.32-22.89).

Conclusion: This study demonstrates a high surgical success rate in patients with ACE, supporting the potential use of augmented surgical doses. Further research is warranted to identify additional prognostic factors and refine treatment strategies for optimal ACE management.