Short-Term Motor and Sensory Outcomes in Acquired Nonaccommodative Esotropia of Childhood

Basic acquired nonaccommodative esotropia patients managed with surgery; a study of 2102 patients

INTRODUCTION

Several studies investigated preoperative clinical features of patients with basic-acquired nonaccommodative esotropia (BANAET); however, their sample sizes were small, and they did not compare the clinical features among cases that needed different surgery times. The main purpose of this study is to compare the preoperative clinical features of patients with BANAET managed with one surgery with patients who underwent two or more strabismus surgery over 10 years.

METHODS

This historical cohort study was performed on the hospital records of 13,252 Iranian strabismic patients who underwent surgery at Farabi eye hospital, Tehran, Iran, from 2012 to September 2022. Of those, 2102 cases with BANAET were selected as the sample size. Data collected included sex, age at the time of first surgery, corrected distance visual acuity (CDVA), refractive error, presence of amblyopia, angle of deviation, and times of surgery.

RESULTS

The mean age was 18.9 ± 15.6 [1200 (57.1%) males and 902 (42.9%) females] and the median age was 14 years. In 1599 (76.1%) patients, esotropia was managed with one surgery; however, 342 (16.3%) cases were managed with two surgeries and 161 (7.6%) patients underwent three or more surgeries. The mean angle of horizontal deviation at distance and near in patients managed with two and ≥3 surgeries was significantly higher than in cases managed with one surgery (P < .001). Amblyopia was observed in 289 (18.1%) patients who were managed with one surgery, 69 (20.2%) patients with two surgeries and 43 (26.7%) patients with three or more surgeries (P < .001). Patients with BANAET managed successfully with only one surgery were younger, had better CDVA, lower astigmatism and less horizontal angle of deviation at distance and near than those who underwent two or more surgeries (all P < .001).

DISCUSSION

The higher astigmatism, lower CDVA, greater angle of horizontal deviation, and higher frequency of amblyopia were found in the preoperative examinations of BANAET patients managed with two or more surgeries compared with cases managed with only one surgery.

Prism adaptation response and surgical outcomes of acquired nonaccommodative comitant esotropia

PURPOSE

To investigate the clinical factors influencing the prism adaptation response of acquired non-accommodative comitant esotropia (ANAET) and evaluate the surgical outcomes.

STUDY DESIGN

Retrospective observational study.

METHODS

This study assessed patients with ANAET who underwent strabismus surgery based on the results of a short prism adaptation test (PAT). Patients wore Fresnel trial prisms based on alternate prism cover tests in outpatient clinics. The cover test was then performed after 15-20 minutes; if the deviation increased, the power of the prism was increased to neutralize the angle. The test was repeated until the angle was stable. Patients were classified as either prism builders (angle increased by ≥ 10 prism diopters [PD] compared with the entry angle) or prism non-builders (angle increased by < 10 PD). The following clinical characteristics were noted: age at onset, age at surgery, duration of esotropia, refractive error, angle of deviation, presence or absence of intermittent esotropia at near, and pre- and postoperative sensory status.

RESULTS

A total of 41 patients (median age, 15.4 years) were evaluated. The mean (standard deviation) spherical equivalent refractions were -3.03 (3.33) diopters (D) and -3.05 (3.23) D in the right and left eyes, respectively. Twenty-seven (66%) patients were prism builders. The prism builders had greater myopia (builders vs. non- builders, right eye: -3.97 [2.97] vs. -1.22 [3.33] D, P = .01; left eye: -4.08 [2.78] vs. -1.07 [3.20] D; P = .003), lower angle of deviation at near (median [interquartile range] 30.0 [20.0, 35.0] vs. 42.5 [35.0, 49.4] PD; P = .009), much more preoperative intermittent esotropia or esophoria at near (44% vs. 7%, P = .03) and diplopia (96% vs. 64%, P = .01), and better postoperative stereoacuity (50 [40, 110] vs. 100 [60, 400] arcsec, P = .02) than the prism non-builders. The overall success rate was 83%, without a significant difference between the two groups (builders vs. non-builders, 89% vs. 71%, P = .21).

CONCLUSION

In cases of myopic refractive error, a small entry angle with intermittency at near, and good binocularity, it is recommended that surgery is performed based on prism-adapted angle to prevent under-correction.

Factors affecting the motor outcome after corrective surgery for acquired comitant esotropia

PURPOSE

To determine the possible predictors of the motor outcome after corrective surgery for acquired comitant esotropia.

METHODS

The study included 40 patients with acquired comitant esotropia. After evaluation of the visual, sensory, and motor status; cycloplegic refraction; fundus examination; and spectacle prescription, all patients underwent corrective strabismus surgery. A successful motor outcome was defined as 0 to 10 prism diopters of horizontal tropia. Statistical analysis of the results was done using the chi-square tests.

RESULTS

At the sixth postoperative month, 90% achieved a successful motor outcome, while 2.5% had a consecutive exotropia >10 prism diopters, and 7.5% had a residual esotropia >10 prism diopters. A statistically significant relationship existed between the motor outcome and the following: preoperative results of the Worth four-dot test at 6 m (p = .011) and 0.33 m (p = .009), preoperative distant (p = .016) and near (p = .017) angles of esotropia with glasses, postoperative near angles of deviation at 1 week (p = .005), 1 month (p < .001), 6 weeks (p < .001), 3 months (p = .001), and 6 months (p < .001) following surgery, postoperative distant angles of deviation at 6 weeks (p < .001) and 3 months (p = .03) following surgery, 6 week (p = .01) and 6 month (p = .036) postoperative results of the Worth four-dot test at 0.33 m, and the 6-month postoperative sensory outcome (p = .006).

CONCLUSION

Preoperative and postoperative sensory and motor functions are predictors of the 6-month postoperative motor outcome.

Preoperative Factors Affecting Stereopsis after Surgical Alignment of Acquired Partially Accommodative Esotropia

BACKGROUND/AIM

Despite successful ocular realignment, many strabismus patients never develop high levels of stereopsis. The purpose of this study was to determine preoperative factors that affect postoperative stereopsis in patients with acquired partially accommodative esotropia (APAET).

METHODS

This was a retrospective chart review of patients who underwent successful surgery for APAET. We compared preoperative factors between patients achieving postoperative stereopsis of 100 seconds of arc or better versus those with worse than 100 seconds of arc.

RESULTS

Fifty-seven patients met our inclusion criteria. Twenty-four (42%) had a final stereopsis of 100 seconds of arc or better. The mean age of onset of esodeviation for patients attaining stereopsis of 100 seconds of arc or better was 31.8 ± 12.9 months, versus 23.9 ± 10.0 months (p = 0.012) for patients with worse than 100 seconds of arc. Duration of constant misalignment was not significantly different between the two groups (30.1 ± 18.5 for patients attaining 100 seconds of arc versus 27.3 ± 18.6 months; p = 0.57). A multivariate regression analysis found older age of onset to be the only predictive factor for achieving better postoperative stereopsis (odds ratio 1.065, 95% CI: 1.014-1.118).

CONCLUSION

Age of onset appears to be the most important factor affecting postoperative stereopsis in patients with APAET. Patients with an age of onset after 36 months tended to have better outcomes regardless of the duration of misalignment. Duration of misalignment and age at surgery did not have a significant impact on postoperative stereopsis in our patient population.

Long-term follow-up of acquired nonaccommodative esotropia in a population-based cohort

PURPOSE

To describe the clinical characteristics and long-term outcomes of children diagnosed over a 30-year period with acquired nonaccommodative esotropia (ANAET).

DESIGN

Retrospective chart review of a population-based cohort.

PARTICIPANTS

All pediatric (<19 years of age) residents of Olmsted County, Minnesota, who were diagnosed with ANAET from January 1, 1965, to December 31, 1994.

METHODS

The medical records of all potential patients identified by the resources of the Rochester Epidemiology Project were reviewed.

MAIN OUTCOME MEASURES

Incidence, clinical characteristics, and long-term motor and sensory outcomes of children with ANAET.

RESULTS

A total of 174 children were diagnosed during the 30-year period, yielding an incidence of 1 in 287 live births. The median age at diagnosis for the 174 patients was 4.0 years (range, 10 months to 18.2 years), and 61% (107) were male (P = 0.009). Although 11% (8/75) of those queried were diplopic, none of the 174 was subsequently diagnosed with an intracranial lesion. During a mean follow-up of 10.9 years (range, 0 days to 37 years), 127 patients (73%) underwent strabismus surgery (mean, 1 surgery; range, 0-3 surgeries). Among the 127 patients who underwent surgery, the median final stereoacuity was 3000 seconds of arc, including 8 patients (6.3%) with ≥ 50 seconds of arc. Patients who were older (>44 months) at ANAET diagnosis (P = 0.005) and without amblyopia at their initial examination (P < 0.001) were more likely to achieve excellent final stereopsis.

CONCLUSIONS

In this population-based cohort, ANAET occurred in 1 in 287 children and was more prevalent among male children. Although diplopia was relatively common, none of the children were found to have an intracranial malignancy. Most patients achieved good motor and sensory outcomes, with the best results among those with a later onset of their deviation and no amblyopia.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.