Effect of hyperopic laser in situ keratomileusis on ocular alignment and stereopsis in patients with accommodative esotropia

Objective: To evaluate the effect of laser in situ keratomileusis (LASIK) on ocular alignment and stereopsis in patients with accommodative esotropia. Design: Retrospective, noncomparative, interventional case series. Participants: Since 1998, 27 patients (mean age, 33.3 years; range, 10-52 years) with comitant esophoria or esotropia and hyperopia meeting eligibility requirements underwent bilateral LASIK for correction of refractive error. Intervention: Bilateral hyperopic LASIK was performed using the Technolas Keracor 217 excimer laser (Bausch & Lomb) in 22 patients and using the Nidek 5000 excimer laser in 5 patients. Main Outcome Measures: Visual acuity (best-corrected and uncorrected), refractive error, ocular alignment, and stereopsis were recorded before and after LASIK. Log transformation of each visual acuity was done before data analysis. Results: Using paired t tests, the mean uncorrected esotropia was significantly reduced from 9.0 prism diopters (PD) (range, 0 [esophoria only] to 20 PD; standard deviation [SD], 7.39) before surgery to 3.3 PD (range, 0-15 PD; SD, 6.20) after surgery (P < 0.0001). Most patients (14 patients, 58%) had a reduction in esodeviation after LASIK, but 10 patients (42%) had no response to surgery, and these patients could not be predicted on the basis of preoperative sensorimotor testing. No patient had a worsening sensorimotor status after LASIK. Nine patients subsequently underwent conventional eye muscle surgery. Conclusions: Hyperopic LASIK was effective in reducing the mean uncorrected esotropia in this group of patients. However, accurately determining those patients most likely to benefit from the procedure was difficult.