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PRK effective for hyperopia with purely accommodative esotropia
Br J Ophthalmol. 2010;94(2):236-240.
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PRK may eliminate the need for spectacle correction in young adults with low to moderate hyperopia associated with purely accommodative esotropia, according to a study.
"We believe that the extra measure of safety provided by PRK warrants consideration, especially if refractive surgery is being considered in school-aged children and young adults, in whom the risks of flap complications and corneal ectasia are likely to be of greater concern," the study authors said.
The retrospective study included 80 eyes of 40 patients with a mean age of 27.9 years. Mean preoperative logMAR best corrected visual acuity was 0.04, and mean preoperative uncorrected visual acuity was 0.3. Mean preoperative spherical equivalent was +3.06 D.
All patients underwent bilateral simultaneous PRK and wore soft contact lenses for 4 days after surgery. No intraoperative or postoperative complications were reported.
Mean BCVA was 0.15 at 1 month after surgery, a statistically significant reduction from the preoperative value (P < .0001); this was attributed to temporary tear film instability. However, mean BCVA returned to preoperative levels at 1 year.
Mean postoperative UCVA was 0.08 at 1 year, a statistically significant improvement (P < .0001).
Mean spherical equivalent was –0.95 D at 1 month, –0.07 D at 1 year and 0.06 D at final evaluation. Refraction was within 0.5 D of emmetropia in all eyes at final evaluation.
Visual acuity, refractive error and ocular alignment were stable after the 1-year evaluation, the authors said.
I take from this study that hyperopic PRK is a safe and effective means of treating purely refractive accommodative esotropia in adults. The key to treating the esotropia in these patients is to be a conscientious refractive surgeon and plan the surgery accordingly to maximize refractive outcomes. Choose appropriate refractive errors, ensure the patient has adequate corneal measurements and maximize tear quality prior to surgery. The patients have the best chance of being orthophoric postoperatively if their refractive target is accurately met. Also, working in conjunction with a strabismologist for accurate classification of the esotropia may be beneficial to meeting the postoperative expectations of the patient.
– Erin Stahl, MD
Pediatric Ophthalmology
Fellow, Children’s Mercy Hospital, Kansas City, Mo.
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