Surgical Treatment for Partially Accommodative Esotropia Associated with a High Accommodative Convergence/ Accommodation Ratio

Partially accommodative esotropia, associated with a high accommodative convergence/accommodation (AC/A) ratio, is an acquired strabismus characterised by a manifest esotropia at distance with a larger constant esotropia at near when fixing on an accommodative target, which responds only partially to spectacle correction. The non-accommodative component of the strabismus is corrected surgically. A number of different surgical approaches have been described in patients with partially accommodative esotropia associated with a high AC/A ratio. These include standard or augmented recession, slanted recession, recession with posterior fixation suture or pulley fixation suture of the medial rectus muscle, or a combination of resection and recession of the MR muscle. In this review, the different surgical treatment modalities for partially accommodative esotropia associated with a high AC/A ratio are discussed.