The surgical management of esotropia with high AC/A ratio

Objective To determine the effectiveness of strabismus surgery as an alternative treatment for high accommodative convergence/accommodation (AC/A) ratio (convergence excess) esotropia. Methods Sixty-five consecutive children with an AC/A ratio of distance-near disparity of 10 prism diopters (PD) or more were studied in a prospective design. Each patient was treated by recession of both medial rectus muscles for the full amount of esotropia measured at near fixation through the full distance hyperopic correction. The magnitude of esodeviation, the AC/A ratio, and the grade of binocularity were measured before and after strabismus surgery. Results The majority of patients were able to maintain satisfactory ocular alignment after surgery, the alignment rates were 76.3% (after 1week), 82.8% (after 1 month), 85.7% (after 6 months), 92.1% (after 1 year). The grade of binocular fusion or stereopsis improved significantly in all of the patients. Conclusions These results demonstrate that strabismus surgery may be more effective in restoring normal stereopsis and binocular fusion for high AC/A patients. Key words: AC/A; Esotropia; Operation