Accommodative ability in exotropia: Predictive value of surgical success

PurposeTo evaluate the state and symmetry of accommodative response in the two eyes of patients with basic intermittent exotropia and to determine whether accommodative response is a predicting factor to the outcome of unilateral recession-resection procedures or symmetric lateral rectus recessions.MethodsDynamic retinoscopy was performed preoperatively on 47 patients with basic intermittent exotropia with the capacity for fusion who were undergoing a first operation for intermittent exotropia. To obtain a clinical measurement of the degree of binocular accommodative response, the monocular estimate method was used. Patients were divided into two groups: those with an “equal effective accommodative response” and those with an “unequal accommodative response” between the two eyes. Both groups received either unilateral recession-resection procedures or symmetric lateral rectus recessions.ResultsThirty-two of 47 patients (68%) showed a persistent interocular difference in accommodative amplitude (asymmetric accommodation) of at least 0.75 D. Among these 32 patients with an “unequal effective accommodation,” 5 of 14 patients (35.7%) receiving lateral rectus recessions had a satisfactory outcome compared with 13 of the 18 patients (72%) receiving recess/resect procedures (p = 0.039). Of the 15 patients with an “equal effective accommodation,” 7 of 8 (87%) receiving recession-resection procedures had a satisfactory outcome compared with 5 of 7 patients (71%) who had lateral rectus recessions (p = 0.57).ConclusionsData suggest that patients with an asymmetric accommodative response benefit more from recession-resection procedures. A decrease in accommodative response of the nondominant eye could be a predicting factor on the outcome of exotropia surgery.