Purpose: To evaluate the surgical outcome of large angle esotropia (minimum of 60 prism diopters -- pd) associated with unilateral low visual acuity (LVA) in which the surgical strategy was applied in order to operate only the non-fixating eye. Patients and Methods: We selected 17 patients with non-accommodative esotropia, LVA (VA<= 0,4 in the non-fixating eye with the better visual correction) and no previous treatment. Patients were classified as good result if they had a postoperative deviation of maximally 10 pd with binocular rotations of up to --2 of medial rectus and +2 of lateral rectus. Exotropia/esotropia between 10 and 15 pd or binocular rotations of ±3 were considered as a regular outcome. Deviations greater than 15 pd or binocular rotations of ±4 were included regarded as poor results. Results: Thirteen (76.4%) patients had counts fingers VA in the non-fixating eye, 2 (11.7%) achieved 0.1 and another two had 0.4. Three of them were also highly myopic (spherical equivalent of --6.00 diopters) in both eyes. Among the 17 patients, 12 (70.5%) had a good surgical outcome, 3 (17.6%) were regular and 2 (11.7%) poor. Conclusions: Strabismus surgery under topical anesthesia proved to be reliable in these special cases of unilateral LVA and often one can avoid surgery of the fixating eye by using this method.
Large esotropias; Monocular surgery; Topical anesthesia
