Characteristics and risk factors for spontaneous and postoperative consecutive exotropia in children with esotropia

Background

To investigate the risk factors for the development of consecutive exotropia (CXT) by comparing patients with spontaneous or postoperative CXT during follow-up with another group of patients who had no deviation or less than 10 prism dioptre (PD) esotropia.

Methods

In this retrospective cohort study, 6 patients with spontaneous CXT (group A), 13 patients with postoperative CXT (group B), and 39 patients with no exotropia (group C) were enrolled. Probable risk factors for CXT were evaluated among the groups. Kruskal-Wallis H test was used to determine if any significant differences were present among the groups. Fisher's exact test or Mann-Whitney U test was used for univariate analyses to compare differences between case groups or between case and control groups. The Bonferroni method was used to conduct multiple comparisons.

Results

The follow-up period of spontaneous CXT patients was significantly longer than that of postoperative CXT and nonconsecutive exotropia patients (p = 0.035 and p < 0.001, respectively). The interval between alignment and CXT onset in spontaneous CXT patients was slightly longer than that in postoperative CXT patients, but not significantly difference (6.50 vs. 5.00 years, p = 0.072). Vertical deviation was associated with a high risk of postoperative CXT (p = 0.001). Most [38 (97.44%)] nonconsecutive exotropia patients had fusion; conversely, the absence of fusion function (p < 0.001) as well as stereoacuity (p = 0.029) were associated with a high risk of CXT.

Conclusion

Vertical deviation and poor binocular function are strongly associated with a high risk of CXT. Children with spontaneous CXT are highly recommended to be followed-up long-term, while they maintain long-term ocular alignment before developing consecutive exotropia from comitant esotropia (CE).

Characteristics of Patients with Accommodative Esotropia Who Need Glasses for Stable Alignment after Myopic Shift

Purpose: We analyzed the characteristics of patients with refractive accommodative esotropia (RAET) who required glasses for stable alignment after a myopic shift.Methods: We retrospectively analyzed the medical records of patients diagnosed with RAET at the initial visit, and who had developed a myopic shift in both eyes over the 5-year follow-up period. To evaluate clinical factors associated with the persistence of esotropia after myopia, the enrolled patients were divided into two groups; patients with RAET who needed glasses for stable alignment after a myopic shift (unstable group) and patients with RAET whose esotropia resolved after a myopic shift (stable group).Results: A total of 55 patients met the inclusion criteria. The mean follow-up period was 13.8 ± 5.7 years (5-27 years). Spherical equivalent (SE) refractive errors at the initial visit were +3.1 ± 1.6 diopters (D) (+1.00 to +7.25 D) and -1.5 ± 0.9 D (-4.38 to -0.5 D) at the last visit. Of the 55 RAET patients, 24 were included in the unstable group and 31 were included in the stable group. No significant differences in gender, age at diagnosis, SE refractive error, or angle of esotropia with glasses were observed between the two groups. However, significantly more patients failed the Lang I test or had anisometropia over 1.5 D at the last visit, and the duration between the onset of esotropia and prescribing glasses was significantly longer in the unstable group than in the stable group.Conclusions: Glasses may be needed for stable alignment even after a myopic shift in RAET patients with long durations of misalignment, poor stereopsis, and anisometropia.

Risk factors for spontaneous consecutive exotropia in children with refractive and nonrefractive accommodative esotropia

PURPOSE

To investigate the risk factors for development of spontaneous consecutive exotropia (ScXT) among patients with refractive and nonrefractive accommodative esotropia (AET).

STUDY DESIGN

Retrospective.

METHODS

Patients who were diagnosed with AET were reviewed from January, 2000 to December, 2016. The patients who developed ScXT after well corrected hyperopia were defined as exodeviation group (n = 51), and the patients who did not show exodeviation and were well controlled with eyeglasses were defined as the control group (n = 117). The changes in cycloplegic refraction, mean angle deviation at initial visit, time till the first correction of esodeviation, presence of amblyopia and accompanying strabismus were compared between the two groups.

RESULTS

The mean interval from the first visit to correction of esodeviation under 8 PD in the exodeviation group was shorter than of the control group (P = 0.008). Patients in the exodeviation group showed more dissociated vertical deviation (DVD) (P = 0.015) and faster reduction in hyperopia per year (more hyperopic eye: P = 0.006; less hyperopic eye: P = 0.034) than the patients in the control group. Exodeviation was found mean 42.31 ± 41.13 months after hyperopia correction. There were no differences in angle deviation at initial visit, and presence of amblyopia.

CONCLUSION

ScXT can be found in AET with faster reduction in hyperopia per year, accompanied by DVD, or in eyes with esodeviation corrected in relatively shorter time. It can be noted even in patients with good alignment over a long-term, so long-term follow-up is recommended.