Skip to main content

Photorefractive keratectomy influences the angle of ocular deviation in strabismus patients with hyperopia

Abstract

Purpose

To evaluate refractive, binocular vision and ocular alignment outcomes of photorefractive keratectomy (PRK) for the treatment of hyperopia in esotropic patients.

Methods

Medical charts of hyperopic patients with full or partial accommodative esotropia (FAE or PAE) or consecutive exotropia (CE) undergone PRK from 2011 to 2014 were reviewed. The primary outcome was to assess the efficacy of PRK in improving ocular alignment. The secondary outcomes were the assessments of uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent (SE) and stereoacuity.

Results

Sixty-four eyes of 32 hyperopic patients were included. Three patients were affected by FAE, 24 by PAE and 5 by CE. All FAE patients and 4 PAE patients underwent only PRK; the remaining 25 patients underwent PRK plus strabismus surgery. After PRK, the mean corrected esodeviation decreased significantly in the overall esotropic population [7.15 ± 9.42 prism diopters (PD) vs. 5.04 ± 8.83 PD; p = 0.03] and in particular in the group with small-angle esodeviation (< 20 PD). Conversely, the only 2 patients with an angle of strabismus ≥ 20 PD as well as all CE patients did not show any postoperative variation of the deviation angle. Mean preoperative BCVA did not differ from postoperative UCVA (p = 0.19), while the mean postoperative SE decreased significantly after PRK (p < 0.0001).

Conclusions

Our study confirmed that PRK eliminates the accommodative component of the deviation. In addition, this procedure seems to reduce or eliminate also the non-accommodative component of esodeviation (especially in small-angle deviation), thus suggesting to postpone strabismus surgery after PRK when esotropia and hyperopia coexist.

This is a preview of subscription content, access via your institution.

References

  1. Donders FC (1864) On the anomalies of accommodation and refraction of the eye with a preliminary essay on physiological dioptrics. New Sydenham Society, London, p 292

    Google Scholar 

  2. Von Noorden GK, Campos EC (2002) Binocular vision and ocular motility; theory and management of strabismus, 6th edn. Mosby, St Louis, MO, p 314

    Google Scholar 

  3. Bilgihan K, Akata F, Or M, Hasanreisoglu B (1997) Photorefractive keratectomy in refractive accommodative esotropia. Eye 11:409–410

    Article  PubMed  Google Scholar 

  4. Hutchinson AK, Serafino M, Nucci P (2010) Photorefractive keratectomy for the treatment of purely refractive accommodative esotropia: six year experience. Br J Ophthalmol 94:236–240

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Pacella E, Abdolrahimzadeh S, Mollo R, Mazzeo L, Pacella F, Mazzeo F, Balacco Gabrieli C (2009) Photorefractive keratectomy in the management of refractive accommodative esotropia in young adult patients. J Cataract Refract Surg 35:1873–1877

    Article  PubMed  Google Scholar 

  6. Nucci P, Serafino M, Hutchinson AK (2004) Photorefractive keratectomy followed strabismus surgery for the treatment of partly accommodative esotropia. J AAPOS 8:555–559

    Article  PubMed  Google Scholar 

  7. Rossi S, Testa F, Santamaria C, Orrico A, Attanasio M, Simonelli F, De Rosa G (2015) Photorefractive keratectomy on purely refractive accommodative esotropia. Semin Ophthalmol 30:25–28

    Article  PubMed  Google Scholar 

  8. Magli A, Forte R, Gallo F, Carelli R (2014) Refractive surgery for accommodative esotropia: 5-year follow-up. J Refract Surg 30(2):116–120

    Article  PubMed  Google Scholar 

  9. Spadea L, Sabetti L, D’Alessandri L, Balestrazzi E (2006) Photorefractive keratectomy and LASIK for the correction of hyperopia: 2-year follow-up. J Refract Surg 22(2):131–136

    Article  PubMed  Google Scholar 

  10. Magli A, Iovine A, Gagliardi V, Fimiani F, Nucci P (2009) LASIK and PRK in refractive accommodative esotropia: a retrospective study on 20 adolescent and adult patients. Eur J Ophthalmol 19(2):188–195

    Article  PubMed  Google Scholar 

  11. Hutchinson AK (2012) Refractive surgery for accommodative esotropia: past, present, and future. Eur J Ophthalmol 22(6):871–877

    Article  PubMed  Google Scholar 

  12. Kirwan C, O’Keefe M, O’Mullane GM, Sheehan C (2010) Refractive surgery in patients with accommodative and non-accommodative strabismus: 1-year prospective follow-up. Br J Ophthalmol 94:898–902

    Article  PubMed  Google Scholar 

  13. Sabetti LL, Spadea LL, D’Alessandri LL, Balestrazzi EE (2005) Photorefractive keratectomy and laser in situ keratomileusis in refractive accommodative esotropia. J Cataract Refract Surg 31:1899–1903

    Article  PubMed  Google Scholar 

  14. Nucci P, Serafino M, Hutchinson AK (2003) Photorefractive keratectomy for the treatment of purely refractive accommodative esotropia. J Cataract Refract Surg 29:889–894

    Article  PubMed  Google Scholar 

  15. Fresina M, Giannaccare G, Gizzi C, Versura P, Campos EC (2015) Photorefractive keratectomy in 22 adult eyes with infantile nystagmus syndrome. J Cataract Refract Surg 41:1448–1453

    Article  PubMed  Google Scholar 

  16. Bagheri A, Abbasi H, Tavakoli M, Baradaran-Rafii A, Shaibanizadeh A, Kheiri B, Yazdani S (2016) Effect of photorefractive keratectomy on nystagmus and visual functions in myopic patients with infantile nystagmus syndrome. Am J Ophthalmol 162:167–172

    Article  PubMed  Google Scholar 

  17. Hunt OA, Wolffsohn JS, García-Resúa C (2006) Ocular motor triad with single vision contact lenses compared to spectacle lenses. Cont Lens Anterior Eye 29(5):239–245

    Article  PubMed  Google Scholar 

  18. Alpern M (1949) Accommodative and convergence with contact lenses. Am J Optom Arch Am Acad Optom 26(9):379–387

    Article  CAS  PubMed  Google Scholar 

  19. Robertson DM, Ogle KN, Dyer JA (1967) Influence of contact lenses on accommodation. Theoretic considerations and clinical study. Am J Ophthalmol 64(5):860–871

    Article  CAS  PubMed  Google Scholar 

  20. Sampson WG (1971) Correction of refractive errors; effect on accommodation and convergence. Trans Am Acad Ophthalmol Otolaryngol 75(1):124–132

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by two Research Grants provided to Prof. Emilio C Campos from “Fondazione Cassa di Risparmio di Bologna” (Bologna, Italy) and “Beneficientia Stiftung” (Vaduz, Liechtenstein).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giuseppe Giannaccare.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (place name of institute/committee) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Giannaccare, G., Primavera, L. & Fresina, M. Photorefractive keratectomy influences the angle of ocular deviation in strabismus patients with hyperopia. Int Ophthalmol 39, 737–744 (2019). https://doi.org/10.1007/s10792-018-0867-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-018-0867-5

Keywords

  • Photorefractive keratectomy
  • Refractive surgery
  • Strabismus
  • Esotropia
  • Hyperopia