In this study the authors targeted patients with non-accommodative decompensating distance esotropia with investigation of prior binocular single vision. Choice of target angle was based on the individual’s fusional amplitudes. The target angle aimed to be less than the distance base-out break fusion point but not excessively overcorrected. Of 31 patients, nine had decompensated microtropia, nine with divergence insufficiency, nine decompensating esophoria and four non-specific esophoria. Patients had symptoms for a mean 46.3 years. Eighty-four percent wore prisms preoperatively. The mean preoperative angle was 20.5PD at distance and 15.1PD at near. Eighty-four percent had lateral rectus resection, two recession / resection and three had bilateral medial rectus recessions. The mean target angle was 21.8PD. Overall there was a drift towards eso deviation of 2.3PD at distance and 2.2PD at near. Comfortable binocular single vision was achieved in primary position for all patients without need for prisms, exercises or reoperations. The authors conclude their individualised approach, taking into account prior binocular single vision, leads to comparable outcomes to that of studies reporting adjustable sutures.

The value of fusional convergence amplitudes in eso deviation surgery without adjustable sutures.
Maudgil A, Raoof N, Burke J.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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