Augmented-dose surgery based on the single Maddox rod test for acute acquired comitant esotropia.

Purpose: To compare the outcomes of augmented-dose surgery for acute acquired concomitant esotropia (AACE) based on either the single Maddox rod test (SMRT), or the prism and alternate cover test (PACT), in cases where there is a clinically significant difference in the deviation using the two tests.

Methods: The medical records of AACE patients who underwent augmented-dose surgery with a difference of ≥5^Δ in preoperative deviations on PACT and SMRT were reviewed retrospectively. Augmented-dose surgery was based on the SMRT or PACT. Success was defined as elimination of diplopia and deviations ≤10^Δ assessed with the PACT (PACT success) or with the SMRT (SMRT success) at both near and distance.

Results: There were 18 patients in the SMRT group and 15 in the PACT group. In the SMRT group, the rate of PACT success was 94%, and SMRT success, 78%; postoperative distance esodeviation on PACT and SMRT were 0.72^Δ ± 1.64^Δ and 5.94^Δ ± 4.73^Δ, respectively. In the PACT group, the rate of PACT success was 80%, and SMRT success, 33%; postoperative distance esodeviation was 4.07^Δ ± 5.15^Δ (PACT) and 13.71^Δ ± 8.26^Δ (SMRT). The SMRT success rate was significantly higher in the SMRT group than in the PACT group (P = 0.010). The postoperative distance deviation was smaller in the SMRT group (P < 0.05).

Conclusions: In our cohort of AACE patients, those whose augmented-dose surgery was based on the SMRT achieved more favorable surgical outcomes than those based on the PACT when there was a difference of ≥5^Δ in preoperative deviations assessed with the two methods.