Muhammad Safdar Iqbal, Syed Ahmer Hussain, Zafar Ullah Qazi.
Refractive accommodative esotropia; management and results.
Professional Med J Dec ;20(2):301-7.

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

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