Photorefractive keratectomy for the treatment of purely refractive accommodative esotropia: 6 years' experience

Abstract

Aims: To report the long term outcomes of photorefractive keratectomy (PRK) for the treatment of hyperopia associated with purely refractive accommodative esotropia.

Methods: This study was a retrospective chart review of 40 patients aged 17-39 years who underwent PRK to eliminate their dependence on glasses. Pre- and postoperative best spectacle corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), refractive spherical equivalent (SEQ), ocular alignment and stereoacuity were reviewed.

Results: Forty patients (80 eyes) with a mean age of 27.9 years were treated for a mean preoperative SEQ of +3.06 D hyperopia. The mean final postoperative SEQ was +0.06 D. Preoperative BSCVA was 0.04 logarithm of the minimum angle of resolution (logMAR), and did not change postoperatively. Mean UCVA significantly improved from 0.30 logMAR preoperatively to 0.08 logMAR post-operatively. Mean pre-operative esotropia at distance and near was 18.6 prism D. All patients were orthophoric without correction at the 1 month, 1 year and final postoperative evaluations. Visual acuity, refractive error and alignment remained stable after the 1 year postoperative examination. Stereoacuity was unchanged in 80% of patients postoperatively. There were no complications.

Conclusion: PRK can be used to treat low to moderate hyperopia associated with purely refractive accommodative esotropia in young adults.

Figure 1

Safety: pre-operative vs. postoperative best spectacle corrected visual acuity (logMAR)

Figure 2

Refractive Efficacy: pre-operative uncorrected visual acuity vs. post-operative uncorrected visual acuity (logMAR)

Figure 3

Predictability: attempted vs. achieved spherical equivalent

Figure 4

Refractive Stability: mean spherical equivalent over time

Figure 5

Alignment stability: mean uncorrected ocular alignment at 1 month, 12 months and final follow-op examinations (distance and near alignment was the same in all patients since they all had a normal AC/A ratio).