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.