Hyperopic LASIK effective for esotropia, but outcomes unpredictable

HOUSTON, Texas — Hyperopic LASIK was effective in reducing mean uncorrected esotropia in a group of patients, surgeons here said. But predicting which patients would benefit from the procedure was challenging.

Researchers performed bilateral hyperopic LASIK on 24 patients with comitant esophoria or esotropia and hyperopia. Surgeries were performed at three clinics in Poland and Russia between 1998 and 2001. Corneal topography and corneal pachymetry were obtained in all patients. Ocular alignment was assessed using prism and cover testing in all gaze positions. Primary position alignment was recorded both with and without glasses.

Initial expectations were that the patient’s response to glasses preoperatively would be predictive of the response to LASIK. Patients were divided into three groups based on their preoperative response to spectacle correction. Twenty patients were deemed to have at least partly accommodative esotropia.

Overall, there was no significant difference in best corrected visual acuity before and after LASIK, and no eye was worse than 20/40 postop. The average corrected and uncorrected esotropia was significantly reduced after the procedure, and overall 14 patients (58%) had a reduction in esodeviation (either esophoria or esotropia) after LASIK.

However, 10 patients had no reduction in esodeviation after LASIK. Preoperative sensorimotor testing could not be used to predict which patients would benefit from the procedure. No patient had a worsening of sensorimotor status after LASIK. Nine patients subsequently underwent conventional eye muscle surgery.

The study is published in the June issue of Ophthalmology.