Accommodative Esotropia Research Articles

Assessment of Refractive Error Changes and Factors for Decompensation in Patients With Fully Accommodative Esotropia.

To determine the factors affecting the risk of deterioration and evaluate the refractive error change in patients with fully accommodative esotropia. Patients diagnosed as having fully accommodative esotropia (esotropic deviation that started before 7 years of age and less than 8 to 10 prism diopters [PD] of esotropia with full hyperopic correction and/or bifocals) were included in this retrospective population-based cohort study. Refractive error changes were recorded. For comparisons, patients were divided into two groups: nondecompensated fully accommodative esotropia group and decompen-sated fully accommodative esotropia group. Two hundred and twenty-three patients met the inclusion criteria. The mean follow-up time was 5.94 ± 0.31 years (range: 5 to 8 years). The changes in spherical equivalent in the younger than 7 years, 7 to 12 years, and 12 to 17 years groups were statistically significant (P < .001). The decrease of hypermetropia was 0.13 diopters/year between 7 and 12 years and 0.06 diopters/year between 12 and 17 years. Forty-one of 223 patients (18.4%) discontinued spectacle therapy during the follow-up period. Hyperopic error and presence of amblyopia were lower, whereas visual acuity level and presence of near-distance disparity were higher in the spectacle discontinuation group (P < .001, .007, .01, and 0.01, respectively). Deterioration of fully accommodative esotropia occurred in 30 of 223 patients (13.5%). Boys were more likely to require strabismus surgery (P = .32). The mean age at presentation, esotropia angle with and without refractive correction at both near and distance fixation, near distance disparity, and inferior oblique overaction were significantly higher in patients with decompensated fully accommodative esotropia. Hyperopic error increased from the initial level until 7 years of age, followed by a myopic shift thereafter. Few children had resolution of fully accommodative esotropia and could discontinue spectacle therapy. Children with male gender, higher esotropia angle, older age at presentation, near-distance disparity, and inferior oblique overaction experienced a greater deterioration of the fully accommodative esotropia. [J Pediatr Ophthalmol Strabismus. 2020;57(4):217-223.].

The Role of Heredity and the Prevalence of Strabismus in Families with Accommodative, Partial Accommodative, and Infantile Esotropia

Objectives:To investigate the prevalence of strabismus in families of a proband with accommodative, partial accommodative, or infantile esotropia (IET), and to evaluate the mode of inheritance and the role of consanguineous marriages in this prevalence.Materials and Methods:Families of probands with comitant strabismus were invited to participate in the study. The family members of 139 subjects with accommodative esotropia (AET), 55 with partial accommodative esotropia (PAET), and 21 with IET agreed to participate. Detailed family trees were constructed. The first- and second-degree relatives were invited for a complete ophthalmological examination, and 518 individuals from 168 families were evaluated. The role of consanguinity, the presence of tropia, phoria (≥8 PD), microtropia, and hypermetropia (≥3.00 D) among first- and second-degree relatives were analyzed.Results:A non-Mendelian pattern was found in 49 families (23%), an autosomal dominant pattern in 39 families (18%), and an autosomal recessive pattern in 6 families (3%). The prevalence of consanguineous marriages among parents of probands was 18.1%, 22.6%, and 14.3% in the AET, PAET, and IET groups, respectively (p=0.652). The prevalence of strabismus in first-degree relatives was 58.9%, 45.5%, and 38.1%, respectively (p=0.07). The prevalence of microtropia in probands’ siblings was significantly higher in the AET group (p=0.034).Conclusion:Sporadic cases and non-Mendelian inheritance were more frequent than autosomal recessive inheritance. Autosomal recessive inheritance was found not to be frequent in consanguineous marriages. The prevalence of strabismus and microtropia was significantly higher in families of esotropia cases than in the general population.

Long-term refractive outcomes in children with early diagnosis of moderate to high hyperopia

ABSTRACT Purpose The purpose of this study was to investigate the long-term outcome of moderate-to-high hyperopic refractive errors in childhood. Methods We reviewed medical records from children diagnosed with hyperopia (≥3D) in the amblyogenic risk factors screening that is performed in a public hospital in Portugal. We included hyperopic children diagnosed between 2001 and 2011 with at least three available ophthalmologic evaluations (including one before the age of 3 years and one after a minimum period of 6 years after the first evaluation). Spherical equivalent (SE) was considered. Results In total, 78 eyes from 39 children met the inclusion criteria (49% male). Mean age at first and last evaluation was 1.8 ± 0.9 years and 10.6 ± 2.7 years, respectively. Median follow-up was 130 months (range 72–193). At baseline evaluation, the mean SE was 4.5 ± 1.4 diopters, 36% of children had a SE ≥5.0 diopters, 23% had partially accommodative esotropia, 26% had accommodative esotropia and 51% had no eye deviation. At the last evaluation, the mean SE was 4.6 ± 1.7diopters. During follow-up, four children developed unilateral amblyopia (one because of anisometropia, three because of anisometropia and strabismus). From these, three recovered with treatment. Until the age of 10 years, the number of children that presented with strabismus did not decrease. Conclusion In our study, children with moderate to high hyperopia did not experience a significant reduction in the power of the refractive error. Although almost 50% of children had an initial deviation, only one had amblyopia at the end of follow-up. Implementing screening strategies for the early detection of this refractive error may prevent long-term vision morbidity in hyperopic children.

Esotropia Outcomes and the Influence of Delay to Wearing Full Hypermetropic Correction

To assess whether delay to full hypermetropic correction wear in children might influence the outcome of a diagnosis of full versus partially accommodative esotropia. All children younger than 7 years who were referred with possible strabismus over a 1-year period were assessed. A standard set of details were documented: age at which esotropia was first noticed, age at which esotropia was confirmed by an orthoptist, age at which glasses were prescribed, and age at which full refractive error was constantly worn. When full-time hypermetropic correction was worn, the type of esotropia was determined. There were 430 children referred. Of these, 117 had a concomitant esotropia (62 males and 55 females). Esotropia was confirmed at 35.47 ± 16.67 months of age (range: 4 to 78 months). There were 51 children (43.6%) with full accommodative esotropia, 57 (48.7%) with partially accommodative esotropia, and 9 (7.7%) with nonaccommodative esotropia. Longer delays between the time at which esotropia was identified and the time at which glasses were prescribed were associated with a reduced likelihood of an outcome of full versus partially accommodative esotropia (odds ratio [OR] = 0.73, 95% confidence interval [CI] = 0.58 to 0.93). Delay to glasses wear for full and partially accommodative esotropia was 1.94 ± 6.4 and 6.24 ± 8.36 months, respectively. Higher average spherical correction scores were associated with a higher likelihood of being in the full accommodative esotropia group (OR = 1.35, 95% CI = 1.07 to 1.69). A child with recent onset concomitant esotropia is more likely to achieve full versus partially accommodative esotropia if the delay to full hypermetropic corrective glasses wear is minimized. [J Pediatr Ophthalmol Strabismus. 2020;57(2):85-89.].

Botulinum toxin in the treatment of partially accommodative esotropia with high AC/A ratio.

To study the outcome of botulinum toxin (BTX) treatment (group 1) in partially accommodative esotropia with high accommodative convergence/accommodation (AC/A) ratio, in comparison with bilateral medial rectus muscles recessions and posterior fixation (group 2). In a retrospective comparative study, children aged 3-8 years old treated between 2011 and 2016, with partially accommodative esotropia with high AC/A ratio, deviation at distance of 10 prism diopters or more, and at least 1 year of follow-up, were included. Visual acuity, alternate prism and cover test, stereoacuity, biomicroscopy, and cycloplegic retinoscopy were carried out at initial, baseline visit, 6 months and 1 year after BTX injection or surgery. Main outcome variables were deviation at distance and near, improvement in stereoacuity, and percentage of success. We used multiple regression or proportional odds analysis to control for potential confounding variables. Of 95 patients, 84 were eligible, 48 children in group 1 and 36 in group 2. Deviation and stereoacuity were similar in the two groups at 6 months, but significantly better in the BTX group at 1 year (median distance deviation 0 prism diopters vs 5 prism diopters, p<0.01), although differences were not clinically relevant. Percentage of success was also significantly better only at 1 year (93% vs 72%, p = 0.01). Change in distance-near disparity was not significantly different in the two groups in the period of study. Botulinum toxin could be superior to, or as effective as surgery, at middle term, in the treatment of partially accommodative esotropia with high AC/A ratio.

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

To investigate the risk factors for development of spontaneous consecutive exotropia (ScXT) among patients with refractive and nonrefractive accommodative esotropia (AET). Retrospective. 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. 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 ± 41.13months after hyperopia correction. There were no differences in angle deviation at initial visit, and presence of amblyopia. 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.

Outcome of Esotropia Surgery in 2 Tertiary Hospitals in Cameroon.

PurposeTo evaluate the ocular alignment following esotropia surgery in our setting.Patients and MethodsWe conducted a cross sectional descriptive study which spanned 19 years, from October 1999 to September 2018 at the Douala General Hospital and the Yaoundé Central Hospital. Complete medical records of patients who underwent surgery for esotropia during the study period were included. Data collected included age at diagnosis, sex, age of onset of esotropia, age at surgery, refractive error, type of surgery performed, pre and post-operative angle of deviation. The outcome was considered good when the postoperative angle was ≤10 prism diopters (PD).ResultsFour hundred and ninety patients with primary esotropia were seen during the study period. Only 155 returned for follow-up after wearing the full cycloplegic correction for a minimum period of 3 months. Accommodative esotropia was found in 32 cases (20.6%). Among the 123 cases requiring surgery, 63 cases underwent surgery (51.2%). Fifty-nine complete records were included (59.3% females and 40.7% males). The mean age at the time of diagnosis was 6.5 ± 6.1 years and the mean age at the time of surgery was 8.7 ± 6.1 years. The mean preoperative angle at distance was 42.8 ±10.8 PD. The outcome was good in 91.5% of cases. No factor influenced the outcome of surgery.ConclusionThe outcome of esotropia surgery was good in this study. This could serve to increase patient motivation to accept surgery in our setting.

Phoria Adaptation: The Ghost in the Machine

ABSTRACT Importance Phoria adaptation is a central tonus mechanism that provides plasticity to binocular alignment. However, its slow dissipation inevitably adulterates our clinical strabismus measurements. Purpose To examine the role of phoria adaptation in normal binocular control, understand its neural substrate, and explore how it can alter our clinical measurements in common forms of strabismus. Methods Investigation into the role of phoria adaptation in maintaining binocular alignment and its role in altering clinical strabismus measurement. Results Phoria adaptation permeates all aspects of binocular alignment. It accounts for the stability of orthophoria, “latent” phorias, tenacious proximal fusion in intermittent exotropia, large fusional vertical amplitudes in congenital superior oblique muscle palsy, the “eating up” of prisms in accommodative esotropia, the smaller measured distance deviation in patients with high AC/A ratio or convergence excess, absence of physiologic skew deviation during head tilt, fusional divergence amplitudes, and spread of comitance. This binocular control system probably arises from a cerebellar learning mechanism that involves input via climbing fibers to the inferior olive, which provide a powerful timing and error signal to the cerebellar Purkinje cells to produce activity-dependent modification analogous to long-term potentiation. Conclusions Phoria adaptation is generated by a central neural integrator that provides inertia, plasticity, and positional stability to human binocular vision.

Profile of Children with Strabismus Managed without Surgery at a Tertiary Eye Hospital of Central Saudi Arabia

Aim: To determine the causes of strabismus among Saudi children who attended a tertiary eye hospital in central Saudi Arabia. Methods: This is a cross-section study included 112 children aged less than 16 years who attended the pediatric ophthalmology unit of King Khaled Eye Specialist Hospital (KKESH) in 2013 with complaints of strabismus, but not undergone surgical correction in the past. Demographic ocular status, refraction, fixation, visual acuity, ocular mobility status, history of eye patching, and penalization in the past were evaluated. Results: We included 112 children with strabismus. Their mean age was 7.7 ±2.5 years, and there were 63 boys (56%). Esotropia and exotropia were found in 99 and 13 children, respectively. Six children had hypertropia. Accommodative esotropia was found in 76 (76.8%) participants. The median angle of deviation in 99 children with esotropia was 30∆D [interquartile range (IQR) 16: 35]. The median angle of deviation in 13 children with exotropia was 25∆D (IQR 22.5: 32.5). High hyperopia, amblyopia, anisometropia, and high astigmatism were found in 65 (58%), 22 (19.6%), 2, and 16 children, respectively. Sixty-six (59%) and 82 (73%) children had undergone eye patching and refractive error in the past six months. Conclusions: Accommodative esotropia was the main cause of strabismus. One-fifth of the participants had amblyopia. Although half of them were given medical/ optical treatment in the past, failure to align eyes and address amblyopia is a matter of concern and needs further investigation.

Acquired Esotropia, Results of Surgical Treatment in Albania

Background: Acquired esotropia is a type of strabismus, which usually manifests around the age of 1-3 years. The aim of this study was to evaluate the outcomes of the surgical treatment of acquired partially accommodative and nonaccommodative esotropia in a group of esotropia patients in Albania. Methods: In total 52 patients aged 2-27 years, diagnosed with acquired partially or non-accommodative esotropia during the period January 2012-December 2017, participated in the study. Patients with complete accommodative esotropia were excluded. Ocular deviation and other parameters were assessed before and after operation and the results were compared to check whether differences were statistically significant. Results: Half (50%) of patients were 2-7 years of age (54% males). Retroposition was the most common surgical procedure, carried out in 50% of cases. Compared to before the intervention, after the intervention there was a significant universal reduction of ocular deviation in all patients at distance or near vision, with or without correction; a significant increase in the proportion of patients acquiring/retaining 3D vision and binocular vision, experiencing no suppression and no excyclotorsion. The most common complication related to surgical intervention was anesthesia-related vomiting (23.1%) and under correction or overcorrection (23.1% of cases). No significant changes were detected in the average visual acuity and the level of manifest and cycloplegic refraction. Conclusion: Surgical treatment for acquired esotropia is an effective procedure, based on significant reduction of mean ocular deviation and improved results of sensory tests after the intervention. Patients with post-surgical undercorrection and overcorrection need to be appropriately followed-up and treated.

Changes in Esodeviation after Inferior Oblique Recession in Patients with Refractive Accommodative Esotropia and Inferior Oblique Overaction.

PurposeTo evaluate the changes in esodeviation after inferior oblique (IO) recession in patients with refractive accommodative esotropia and IO overaction.MethodsGraded IO recession was performed in 68 patients who were diagnosed with refractive accommodative esotropia with IO overaction. The patients were followed for at least 3 months after surgery and the angle of esodeviation with correction was evaluated at distance and near at each follow-up evaluation. The patients were divided into two groups: patients who underwent unilateral IO recession (UIO-Rec) and patients who underwent bilateral IO recession (BIO-Rec). The change in esodeviation after surgery was compared between the two groups.ResultsA total of 68 patients were enrolled in this study, with 38 patients in the UIO-Rec group and 30 in the BIO-Rec group. In the UIO-Rec group, there was no statistically significant difference in esodeviation before and after surgery. In the BIO-Rec group, esodeviation at distance increased significantly 1 day postoperatively (p = 0.033). However, esodeviation returned to the preoperative value one week after surgery (p = 0.665). Changes in esodeviation at distance were significantly greater in the BIO-Rec group than in the UIO-Rec group one day after surgery (p = 0.044).ConclusionsBilateral IO-weakening surgery induced a transient increase in esodeviation in patients with refractive accommodative esotropia. However, we found no evidence that well-controlled esotropia with corrected hyperopia became decompensated after IO-weakening surgery, as induced esodeviation was minor and temporary.

影响屈光性调节性内斜视患者立体视发育的因素

影响屈光性调节性内斜视患者立体视发育的因素

Multimodal imaging in non-syndromic microphthalmia: a case series

Microphthalmia is a rare congenital or developmental anomaly in which the globe is abnormally small. Between one-third and one-half of affected individuals have microphthalmia as part of a syndrome that affects other organs and tissues in the body. These forms are described as syndromic. When microphthalmia occurs by itself, it is described as nonsyndromic or isolated. We aimed to describe the clinical and paraclinical features of nonsyndromic microphthalmia through three cases. The first patient was an 8-year-old female child who presented with bilateral refractive accommodative esotropia due to hypermetropia. She was diagnosed with bilateral posterior microphthalmia qualified as non-syndromic and simple. Eyeglasses prescription has been upgraded and a 6-month clinical monitoring has been undertaken. The second case was about a 16-year-old female patient who had a bilateral amblyopia due to a non-syndromic microphthalmia. She presented with unilateral high intra-ocular pressure. Anterior Segment OCT showed unilateral narrow angle with iridotrabecular contact in the right eye. Microphtalmia has been qualified as complex in the right eye and simple in the left eye. The patient has been put under IOP-lowering topical medication for the OD and peripheral YAG laser iridotomy has been performed. IOP reduction was noticed within five days. The third case was a 7-year-old male child with bilateral non-syndromic complex nanophthalmia. Ophthalmic examination revealed bilateral microcornea and OCT of the macula showed bilateral retinal folds with apical surface corrugations. Optical correction and active surveillance were adopted. Non-syndromic microphthalmia is a rare and potentially blinding disease. We highlighted the interest of ocular ultrasound, especially in young hypermetropic children completed by an examination in OCT. Non-invasive, objective and repeatable, OCT seems to be of great interest in both the diagnosis and the monitoring of microphthalmia.

Clinical risk factors and management of consecutive strabismus

Material and Methods: The study was conducted at Pediatric Ophthalmology and Strabismus clinic at our tertiary care institute PGIMS, Rohtak. Patients who developed consecutive tropia after squint surgery for horizontal strabismus from April 2015 to August 2016 were enrolled. Continued esodeviation after surgery for exotropia was termed as consecutive esotropia and post-operative exodeviation present even 2 weeks after surgery for esotropia was termed as consecutive exotropia. The patients were followed up for at least 3 months. Ocular movements, preoperative deviation (PBCT), presence of vertical deviation, DVD, A-V patterns was noted, AC/A ratio, sensory status by Worth Four Dot Test and Titmus test. Immediate post-operative deviation was measured. Follow-up was done at 2 weeks, 6 weeks, 3 months and 6 months. Results: There were a total of 92 patients who underwent squint surgeries for horizontal strabismus. 12 patients developed consecutive squint. Out of 12 patients, 10 patients developed consecutive exotropia and 2 patients developed consecutive esotropia. The mean pre-operative deviation of resolved cases in both the groups was 458.16PD for near and 42.58.66PD for distance and the mean pre-operative deviation of unresolved cases in both the groups was 39.1610.68PD for near and 38.336.83PD for distance. Discussion: In our study, the incidence of consecutive squint was 13%. Out of which 10.86% had consecutive exotropia and 2.17% had consecutive esotropia. The patients who developed consecutive squint had infantile esotropia, infantile exotropia, partially accommodative esotropia and non- accommodative acquired esotropia. Amongst consecutive exotropias group, 40% cases resolved while in consecutive esotropia group, 50% resolved. Conclusion: Consecutive squint is a complication of squint surgery which can develop immediately after surgery or years later. Taking care of the errors during measurement of pre-operative deviation improves the success of surgical outcom

Long-term outcomes of prismatic correction in partially accommodative esotropia.

In partially accommodative esotropia (PAET), prism glasses can correct small angles of residual esotropia but the long-term effect of prismatic correction alone without surgery has not been reported. We aimed to investigate the long-term outcome of prism glasses after full hypermetropic correction for PAET. This retrospective, case-control study was performed for children aged 10 years or younger with a residual esotropia of ≤ 20 prism diopters (PD) after full hypermetropic correction who were fitted with prism glasses and followed-up for 3 years or more. Clinical characteristics and the angle of esodeviation were obtained at each follow-up examination. Successful motor outcome after 3 years of prismatic correction was determined if the residual angle of esotropia after full hypermetropic correction was ≤ 10PD. Patients who eventually weaned off prism glasses were noted. Among 124 patients, 30.6% achieved success and 7.3% weaned off prism glasses after 3 years of prism-wear. Smaller amount of latent esodeviation (P = 0.001) revealed by prism adaptation and good fusional response at near with the Worth 4-dot test were significant prognostic factors of success by multivariate analysis (P = 0.033). After 3 years of wearing prism glasses, the rate of improvement in stereoacuity was higher in the Success group (60.5% vs 27.9%) (P = 0.001), however, there was no significant difference between the prism-weaned group and prism-wearing group within the Success group (P>0.05). Prism glasses for small angle PAET can be a treatment option in patients who have a small angle of latent esodeviation revealed by prism adaptation and good sensory fusion at near. Otherwise, early surgery may be advisable as the majority of patients showed suboptimal outcome even after long-term prism-wear.

Accommodative esotropia–A clinical study

Accommodative esotropia–A clinical study - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.091, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Ophthalmol

Post-operative analysis of pediatric esotropia associated with high hypermetropia

BackgroundTo describe clinical features, evaluation, surgical management and outcomes in children with esotropia associated with high hypermetropia.MethodsMedical records of healthy children who received strabismus surgery for accommodative esotropia with hypermetropia larger than spherical equivalence of + 4.0 diopters from 2009 to 2015, were reviewed.ResultsA total of 47 patients were identified. The average age was 2.9 years old. The average spherical equivalence of cycloplegic refraction was + 6.0 diopters (D). All patients presented with large angle esotropia with spectacle correction. Average age of esotropia onset was 1.3 years. Average time between the onset of esotropia to spectacle correction was 7.2 months. Average duration between onset of constant esotropia to strabismus surgery was 28.1 months. Average duration between spectacle correction to strabismus surgery was 21.8 months. Post-operatively, 74.5% of patients achieved ocular alignment within 10 prism diopters (PD) of orthotropia. Overall, 66.0% patients developed sensory fusion. For patients who achieved surgical success, 71.4% developed sensory fusion, compared at 50.0% for patients who were over- or under-corrected (p = 0.18). For patients who received hyperopic spectacles within 6 months of esotropia onset, 92.3% developed sensory fusion, compared with 54.5% for patients who received hyperopic spectacles at 6 month or later after esotropia onset (p = 0.02).ConclusionsStrabismus surgery for esotropia with high hypermetropia has high rate of surgical success with low rate of under- or over-correction. There is a trend toward higher rate of sensory fusion for patients with surgical success. Shorter time interval between esotropia onset and receiving hyperopic spectacles is associated with higher rate of sensory fusion development.

Lateral rectus sag and recurrent esotropia in children

To describe the clinical and intraoperative findings of an anatomic abnormality in children that resembles sagging eye syndrome documented in older adults and that led to recurrent esotropia after surgery. We reviewed records of 4 patients with substantial recurrent esotropia after bilateral medial rectus recession who required subsequent surgery combining lateral rectus resection with correction of the anatomic abnormality affecting the lateral rectus path. Binocular alignment was sequentially analyzed. Three young patients (2-3years of age) presented with acquired esotropia but minimal cycloplegic refractive error. The fourth patient (14years of age) initially had moderate hyperopia and partially accommodative esotropia, but subsequently developed marked bilateral overelevation in adduction. In all patients, esotropia recurred within 5Δ of preoperative deviation after bilateral medial rectus recession. Surgical exposure demonstrated that bilateral lateral rectus paths were inferiorly displaced more than one-half tendon width from their normal paths near the globe's equator, despite normal scleral insertions. Equatorial myopexy and lateral rectus resection resulted in stable esotropia correction. Lateral rectus sag in children creates a type of acquired esotropia and overelevation in adduction poorly responsive to standard surgery but correctable with lateral rectus resection and equatorial myopexy that normalizes the lateral rectus path through permanent scleral fixation.

Long-term development of refractive error in refractive, nonrefractive and partially accommodative esotropia.

Accommodative esotropia (AE) is a convergent deviation due to an excess of the convergence linked to the innervational stimulus for accommodation and it is usually associated to the presence of hyperopia. The development of hyperopia over time has been widely described but the lack of comparative analysis among accommodative esotropia subtypes, does not allow to verify the existence of different developmental patterns. In this study we aimed to describe the long term changes of refractive error in patients affected by accommodative esotropia as a function of the strabismus type: refractive (RAE), non-refractive (NRAE) and partially accommodative esotropia (PAE). The medical records of 66 patients (24 RAE, 22 PAE, 20 NRAE), who wore the full correction of their cycloplegic refraction error during the entire follow up period, were retrospectively reviewed. Mean outcome was the analysis of the variations, among groups, of refractive error over time; differences between mild (≤3.00D) and high (≥5.00D) hyperopia, effects of amblyopia and relationship with AC/A ratio were also investigated. All patients were followed up from approximately 4 years of age to 20, with mean follow up of 16.06±0.29 years. Our results described similar non-linear trend of refractive error development among groups. The initial increase of hyperopia (up to 7–8 years) was followed by a decreasing trend persisting up to adulthood (approximately 20 years of age). During this period, spherical equivalent decreased at a lower mean annual rate in patients affected by RAE (-0.07D) compared to other groups (NRAE -0.11D, p = 0.003 and PAE 0.13D, p = 0.002). In all groups, however, significant amount of hyperopia was found at last examination; indeed the observed difference in SE values from baseline to the end of follow up, was not significant (RAE: +0.27D, 95% C.I. -0.49 to +1.04D, p = 0.472; PAE: -0.69D, 95% C.I. -1.67 to +0.28D, p = 0.154; NRAE: -0.39D, 95% C.I. -1.11 to +0.34D, p = 0.278). AC/A ratio, amblyopia and amount of initial hyperopia appeared to have no significant role in longitudinal change of the refractive error. In conclusion, this study provides a complete overview, from childhood to adulthood, of refractive error development in different form of accommodative esotropia.

Long-term motor and sensory outcomes after surgery for the nonaccommodative component of partially refractive accommodative esotropia

To report long-term motor and sensory outcomes after surgery for the nonaccommodative component of partially refractive accommodative esotropia (PRAET). The medical records of consecutive patients ≤11years old operated for the nonaccommodative component of PRAET and followed postoperatively for at least 10years were retrospectively reviewed. A total of 47 patients were included (median age, 3.0years). The mean postoperative follow-up was 12.15±2.05years (range, 10.00-17.50years). Overall, 23 patients (49%) had surgical success; 10 (21%), decompensation; and 7 (15%), esotropia with a high ratio of accommodative convergence to accommodation (AC/A) or consecutive exotropia. The median age at surgery, mean cycloplegic refraction, median near and distance deviation, presence of binocular vision, and amblyopia did not predict decompensation, a high AC/A ratio esotropia, and consecutive exotropia. Eight patients (18%) achieved stereopsis. Patients with an older age at onset (2.87±1.31years) and a shorter duration of strabismus (≤4years) achieved better stereopsis. Nearly half of our patients with PRAET achieved a successful ocular alignment after surgery for the nonaccommodative component. Some developed decompensation, a high AC/A ratio esotropia, or consecutive exotropia. Few patients achieved stereopsis. Older age at onset and a shorter duration of strabismus predicted a better stereopsis outcome.