REFRACTIVE ACCOMMODATIVE ESOTROPIA;

Abstract

Purpose: To determine the efficacy of all time wear of full cycloplegic correction in the management of refractiveaccommodative esotropia. Design: Descriptive study using non-probability purposive sampling technique. Setting: Ophthalmology OPDand Department of Nishtar Hospital, Multan. Period: Oct 2009 to Sep 2010. Material and Methods: All children with accommodativeesotropia associated with hyperopia were included in the study. The features studied were ocular alignment, association of anisometropiawith strabismus and amblyopia, improvement in deviation of squint after amblyopia therapy and full cycloplegic hyperopic correctionand regain of binocular single vision and requirement for surgery in patients with accommodative esotropia with hyperopia. Results:Forty four children with refractive accommodative esotropia were identified. Cycloplegic refraction was done for all patients and fullcycloplegic correction was given. At presentation 36.4% of children were amblyopic in either eye and most of them had anisometropichypermetropia. The esotropia was present in more hypermetropic eye. 63.6% of the patients became straight with glasses only andanother 25% became straight after amblyopia therapy. Fusion with gross stereopsis was demonstrated in 75% of patients. Cycloplegicrefraction remained stable throughout the follow up period. None of these patients was able to discontinue glasses and maintainalignment. Surgery was required in only 11.4% of total patients. Conclusions: Most children with refractive accommodative esotropiahave an excellent outcome in term of visual acuity, ocular alignment and binocular single vision with the glasses. Full cycloplegiccorrection and amblyopia therapy resulted in marked reduction in the deviation of squint and improvement in visual acuity of theamblyopic eye as compared with the prevalence at presentation. The degree of hyperopia remains unchanged with poor prospect fordiscontinuing glasses wear.