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. Laser in situ keratomileusis, laser epithelial keratomileusis and Artisan phakic intraocular lens implantation were performed. All treated eyes had a BCVA of at least 6/18 preoperatively. One year postoperatively, visual acuity, refractive error and ocular alignment were reassessed.

Results 28 patients (nine male, 19 female) of mean age 33.0±10.0 years (range 20–59) were included in the study. Esotropia was present in 16 patients; nine fully accommodative, three partially accommodative and four non-accommodative. Twelve patients had exodeviations; 10 exotropia and two exophoria and a 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.

Conclusions 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 hyperopic patients to prevent decompensation of ocular alignment over time.