Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, Portugal.
Ophthalmic Res. 2022;65(4):361-376. doi: 10.1159/000523816. Epub 2022 Feb 28.
Accommodative esotropia (AET) is characterized by an esodeviation of the eyes due to uncorrected hyperopia, deficient fusional divergence, or high accommodative convergence. Decreasing hyperopia would reduce accommodative convergence and strabismus. We sought to review the existing evidence regarding the outcomes of refractive surgery in patients with AET.
A four-database search (Pubmed, ISI Web of Science, Cochrane, and Scopus) was performed from inception to March 2021 using the following MeSH terms: ("Refractive Surgical Procedures" OR "Keratomileusis, Laser In Situ" OR "Photorefractive Keratectomy" OR "Lens Implantation, Intraocular") AND ("Esotropia" OR "Accommodative Esotropia" OR "Refractive Esotropia" OR "Accommodative Strabismus"). No meta-analysis was performed due to studies' heterogeneity.
Twenty-eight studies including 22 case series enrolling 378 patients and 6 case reports enrolling 8 patients were selected among 185 original abstracts. In the case series, a total of 378 patients (726 eyes) were recruited with an age range of 8-52 years. All studies reported mean follow-up periods of at least 12 months. Photorefractive keratectomy was performed in 7 studies, laser-assisted in situ keratomileusis in 9 studies, laser-assisted sub-epithelial keratectomy was reported in 1 study, and 3 studies implanted intraocular lenses, including iris-fixated and collamer. Considering the adult patients with a preoperative corrected esodeviation ≤10 prism diopters (PD) (n = 129), all but 5 (3.9%) presented orthophoria or ≤10PD after refractive surgery. All children but 4 (4.5%) ended up with an esodeviation ≤10PD after surgery with those exceptions being in the range of 11-15PD. Six case reports were included in this review, comprising a total of 8 patients (16 eyes) with an age range of 7-34 years and a follow-up range of 4-48 months. Six case reports were included in this review, comprising a total of 8 patients (16 eyes) with an age range of 7-34 years and a follow-up range of 4-48 months.
Evidence produced so far points out that refractive surgery may be an alternative for spectacle correction for adults with AET ≤10PD. There is not enough evidence to recommend its use for patients under 18 years of age. The safety and predictability of these procedures for this purpose remains unclear as the selection criteria used for these patients are much different than the usual indications and there are no studies with long-term follow-up.
调节性内斜视（AET）的特征是眼睛由于未矫正的远视、融合性发散不足或高调节性集合而出现内斜视。降低远视会减少调节性集合和斜视。我们旨在回顾有关 AET 患者屈光手术结果的现有证据。
从开始到 2021 年 3 月，我们在四个数据库（Pubmed、ISI Web of Science、Cochrane 和 Scopus）中使用以下 MeSH 术语进行了搜索：（“屈光手术程序”或“角膜磨镶术，激光原位”或“光折射性角膜切除术”或“眼内透镜植入术”）和（“内斜视”或“调节性内斜视”或“屈光性内斜视”或“调节性斜视”）。由于研究的异质性，未进行荟萃分析。
在 185 篇原始摘要中，我们选择了 28 项研究，其中包括 22 项病例系列研究，共纳入 378 例患者和 6 项病例报告，共纳入 8 例患者。在病例系列研究中，共招募了 378 例患者（726 只眼），年龄 8-52 岁。所有研究均报告了至少 12 个月的平均随访期。有 7 项研究行光折射性角膜切除术，9 项研究行激光辅助原位角膜磨镶术，1 项研究行激光辅助上皮下角膜切除术，3 项研究植入眼内透镜，包括虹膜固定和 collamer。对于术前矫正性内斜视≤10 棱镜度（PD）的成年患者（n=129），除 5 例（3.9%）外，所有患者术后均为正位或≤10PD。所有儿童（n=244）术后内斜视≤10PD，但有 4 例（4.5%）除外，斜视度在 11-15PD 之间。本综述共纳入 6 项病例报告，共纳入 8 例患者（16 只眼），年龄 7-34 岁，随访时间 4-48 个月。
迄今为止的证据表明，屈光手术可能是矫正≤10PD 的 AET 成年患者眼镜矫正的一种替代方法。对于 18 岁以下的患者，尚无足够的证据推荐使用屈光手术。对于这些患者，选择标准与常规适应证大不相同，而且没有长期随访的研究，因此这些手术的安全性和可预测性尚不清楚。
