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Part-time occlusion therapy resulted in the conversion of the basic and convergence insufficiency types to pseudodivergence excess and basic types in more than half of the intermittent exotropes. Future studies on correlation between type conversion and surgical outcome would be necessary.

PurposeTo report antielevation syndrome with restriction of elevation on abduction in the operated eye and overaction (OA) of the inferior oblique muscle (IO) of the contralateral eye after unilateral IO anteriorization (AT).MethodsMedical records were reviewed retrospectively in 8 of 24 patients who underwent unilateral IOAT. Four patients were referred from other hospitals after the same surgery.ResultsFour patients had infantile esotropes. The rest showed accommodative esotropia, superior oblique palsy, exotropia, and consecutive exotropia. The mean amount of hyperdeviation was 16.3 PD (10 ~ 30). The mean restriction of elevation on abduction in the operated eye was -1.6 (-1 ~ -4) and IOOA of the contralateral eye was +2.7 (+2 ~ +3). IOAT of nonoperated eyes in 4 patients, IO weakening procedure of anteriorized eyes in 2 patients, and IO myectomy on an eye with IOAT in 1 patient were performed. Ocular motility was improved after surgery in all patients.ConclusionsUnilateral IOAT may result in antielevation syndrome. Therefore bilateral IOAT is recommended to balance antielevation in both eyes. A meticulous caution is needed when performing unilateral IOAT.

Symptoms of 3D asthenopia were related to the presence of exodeviation but not to esodeviation. This may indicate that S3D symptoms are closely related to the convergence demand.

BackgroundTo investigate the accommodative loads change needed to maintain binocular fusion in patients with intermittent exotropia (IXT).MethodsSeventeen consecutive patients with basic IXT and 15 normal controls were recruited. The WAM-5500 autorefractor (GrandSeiko, Fukuyama, Japan) was used to measure refractive error (D) under binocular and monocular viewing conditions at 6 m, 50 cm, 33 cm and 20 cm. The difference between binocular and monocular refractive error (D) at each distance defined the change in the accommodative load. The changes in accommodative load were compared between IXT patients and normal controls. We also investigated the change in accommodative loads according to the fixing preference in patients with IXT.ResultsIn IXT patients, the mean angles of deviation were 20.2 ± 7.19 and 21.0 ± 8.02 prism diopters at 6 m and 33 cm, respectively. Under binocular viewing, the changes in accommodative loads of each eye in IXT patients were significantly higher at 50, 33 and 20 cm than those of normal controls (p < 0.05, all). The changes in accommodative loads of fixating and deviating eyes at 6 m were not significantly different between IXT patients and normal controls (p = 0.193, 0.155, respectively). The changes in accommodative loads of the fixating eye at each distance were not significantly different from those of the deviating eye in IXT patients (p > 0.05).ConclusionThe changes of accommodative loads at near fixation increased more in IXT patients than they did in normal controls while maintaining binocular fusion.