Surgery for esotropia under topical anesthesia.
OBJECTIVE
To compare a surgically adjusted dose of strabismus surgery using topical anesthesia in cooperative patients with dosage guidelines adapted to the surgeon's personal technique using sub-Tenon's anesthesia.


METHODS
Randomized, controlled, single-site clinical trial.


METHODS
Sixty patients with nonparalytic, nonrestrictive esotropia who were cooperative for surgery under topical anesthesia.


METHODS
Twenty-eight patients were assigned to topical anesthesia, and 32 patients were assigned to sub-Tenon's anesthesia. Visual acuity, refraction, and deviation angle were determined in all patients preoperatively and postoperatively, and stereoacuity was measured postoperatively. Deviation angle was measured by simultaneous and alternate prism and cover test, and stereoacuity was measured using Randot circles (Stereo Optical Co., Chicago, IL). The amount of surgery under topical anesthesia was adjusted intraoperatively.


METHODS
The amount of surgery used in the 2 treatment groups (measured in millimeters and millimeter/degree of deviation angle) and 6-month motor and stereoacuity outcomes.


RESULTS
Patients in the topical group required 3.2 mm less surgery on average than those in the sub-Tenon's group (5.9 and 9.1 mm, respectively; 0.4 and 0.6 mm of recession/degree, respectively) (P<0.01). Motor success (84% and 75%, respectively, P=0.38) and stereoacuity (339.6 and 323.9 arc seconds, respectively, P=0.87) at 6 months were similar in the 2 groups.


CONCLUSIONS
Topical anesthesia requires a smaller amount of surgery and number of operated muscles to correct esotropia compared with classic surgery guidelines adapted to the surgeon's personal technique.
Tejedor
Jaime
J
Department of Ophthalmology, Hospital Ramón y Cajal, Madrid, Spain. jtejedor.hrc@salud.madrid.org
Ogallar
Consuelo
C
Rodríguez
José M
JM
D000293:Adolescent; D000328:Adult; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D004948:Esotropia / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D011343:Procaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D012029:Refraction, Ocular / Q000502:physiology; D013748:Tetracaine / Q000008:administration & dosage; D014792:Visual Acuity / Q000502:physiology
D000779:Anesthetics, Local; D013748:Tetracaine; D011343:Procaine; D008012:Lidocaine; C005298:benoxinate