title: Surgical management of intermittent exotropia with high AC/A ratio.
abstract: BACKGROUND
  A subgroup of patients with intermittent exotropia have a high AC/A ratio, which places them at risk for esotropia at near after surgical treatment of their distance deviation.
  
  
  METHODS
  A retrospective review of six patients with intermittent exotropia and a high AC/A ratio who were simultaneously treated with lateral rectus recessions to fully correct their exotropia at distance and placement of posterior fixation sutures on both medial rectus muscles in hopes of preventing an esotropia at near after surgery.
  
  
  RESULTS
  Despite the persistence of a high postoperative AC/A ratio as assessed by the gradient method, five of six patients achieved stable postoperative alignment at distance and near without bifocals. One patient required postoperative bifocal correction for intermittent esotropia at near.
  
  
  CONCLUSIONS
  In patients with intermittent exotropia and a high AC/A ratio, posterior fixation of the medial rectus muscles at the time of lateral rectus recessions enables the surgeon to fully correct the distance deviation and minimizes the risk of postoperative esotropia at near.
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Brodsky
authors.forename: K J
authors.initials: KJ
authors.lastname: Fray
mesh_terms: D000065:Accommodation, Ocular; D002648:Child; D002675:Child, Preschool; D003290:Convergence, Ocular; D005099:Exotropia / Q000601:surgery*; D005260:Female; D005403:Fixation, Ocular; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery*; D012189:Retrospective Studies; D015348:Vision, Binocular