Changes in Esodeviation after Inferior Oblique Recession in Patients with Refractive Accommodative Esotropia and Inferior Oblique Overaction

Purpose: To evaluate the changes in esodeviation after inferior oblique (IO) recession in patients with refractive accommodativeesotropia and IO overaction. Methods: Graded IO recession was performed in 68 patients who were diagnosed with refractive accommodative esotropiawith IO overaction. The patients were followed for at least 3 months after surgery and the angle of esodeviation with correctionwas evaluated at distance and near at each follow-up evaluation. The patients were divided into two groups: patientswho underwent unilateral IO recession (UIO-Rec) and patients who underwent bilateral IO recession (BIO-Rec). The change inesodeviation after surgery was compared between the two groups. Results: A total of 68 patients were enrolled in this study, with 38 patients in the UIO-Rec group and 30 in the BIO-Rec group. In the UIO-Rec group, there was no statistically significant difference in esodeviation before and after surgery. In the BIO-Recgroup, esodeviation at distance increased significantly 1 day postoperatively (p = 0.033). However, esodeviation returned tothe preoperative value one week after surgery (p = 0.665). Changes in esodeviation at distance were significantly greater inthe BIO-Rec group than in the UIO-Rec group one day after surgery (p = 0.044). Conclusions: Bilateral IO-weakening surgery induced a transient increase in esodeviation in patients with refractive accommodativeesotropia. However, we found no evidence that well-controlled esotropia with corrected hyperopia became decompensatedafter IO-weakening surgery, as induced esodeviation was minor and temporary.