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Refractive surgery in patients with accommodative and non-accommodative strabismus - one year prospective follow up
  1. caitriona kirwan1,
  2. Michael O'Keefe2,*,
  3. Gillian O'Mullane3,
  4. Claire Sheehan3
  1. 1 Childrens University Hospital, Temple Street, Dublin, Eire;
  2. 2 Dublin Children's Hospital, Ireland;
  3. 3 Childrens University Hospital, Dublin, Ireland
  1. Correspondence to: Michael O'Keefe, Dublin Children's Hospital, Department of Ophthalmology, The Children's Hospital, Temple Street, Dublin 1, x, Eire; mokeefe{at}


Aim: To determine the efficacy and safety of keratorefractive surgery in patients with accommodative and non-accommodative strabismus in a prospective study.

Methods: Preoperative assessment included uncorrected (UCVA) and best corrected visual acuity (BCVA), manifest and cycloplegic refraction and orthoptic examination. LASIK, LASEK and Artisan phakic intraocular lens implantation were performed. All treated eyes had BCVA of at least 6/18 preoperatively. One year postoperatively, visual acuity, refractive error and ocular alignment were reassessed.

Results: 28 patients (9 male, 19 female) of mean age 33.0±10.0 years (range 20 to 59). Esotropia was present in 16 patients; 9 fully accommodative, 3 partially accommodative and 4 non-accommodative. Twelve patients had exodeviations; 10 exotropia and 2 exophoria and history of strabismus surgery. Excellent visual and refractive outcomes were obtained postoperatively. There was no loss and one eye gained a line of BCVA. Fully accommodative esotropes attained orthophoria or microtropia. Improved ocular alignment occurred in partially accommodative esotropes and myopic exotropes. No patient experienced decompensation of strabismus or diplopia.

Conclusion: Refractive surgery may be performed successfully in patients with accommodative and non-accommodative strabismus. However, great care must be taken when determining patient suitability. This is of particular importance in young hyperopes to prevent decompensation of ocular alignment over time.

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