Characteristics and Surgical Outcomes of Comitant Esotropia in an Adult Population Between 18 and 60 Years Old

Abstract

PurposeTo describe the clinical characteristics and surgical outcomes of adults with comitant non-accommodative esotropia. DesignRetrospective case series MethodsRetrospective review of medical records of patients 18 to 60 years old with comitant esotropia who underwent strabismus surgery at a tertiary eye care center between 2014 and 2023. The etiology of esotropia was categorized into three groups based on the disparity between near-distance angles of deviation: 1. basic esotropia (ETBA); 2. esotropia divergence insufficiency pattern (ETDI); or 3. esotropia convergence excess pattern (ETCE). The main outcome measures were strabismus characteristics and motor and sensory surgical outcomes. Surgical motor success was defined as a deviation that measured ≤ 10 prism diopters (PD). ResultsOf the 219 that met the inclusion criteria, most patients were female (140, 64%) and had a mean age of 36.7 ± 12.3 years (range 18-60 years). The majority were myopic (157, 72%) and reported diplopia (176/219, 80.3%). The ETCE group had the largest mean deviations at both distance (45.5 ± 11.5 PD) and near (64 ± 12.3 PD) while the ETBA group had the largest ranges at distance (31 ± 13.5 PD, range 3-90) and near (30 ± 15 PD, range 2- 85). Bilateral medial rectus recession (BMR) and unilateral recess-resect (R&R) procedures were performed with equal frequency (both 48%). Motor and sensory success were achieved more often with R&R than BMR, although only motor success was statistically significant (87.8% vs. 73.2%, p=0.0375 and 93.3% vs. 85.5%, p=0. 15 respectively). At the last encounter, 88.1% (119/135) of patients with pre-operative diplopia achieved single binocular vision. ConclusionsRegardless of the pattern of esotropia, strabismus surgery in adults with comitant non-accommodative esotropia resulted in good motor and sensory outcomes.