Major Article
Esotropia with an accommodative component after surgery for infantile esotropia compared to primary accommodative esotropia

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Purpose

To compare the clinical outcomes of patients with an esotropia with an accommodative component after infantile esotropia surgery and patients with primary refractive accommodative esotropia.

Methods

The medical records of patients with postoperative (secondary group) and primary refractive accommodative esotropia (primary group) were reviewed retrospectively. Changes in ocular alignment, refractive error, weaning rate, decompensation rate over time, and sensory outcomes were compared.

Results

The overall change in ocular deviation with glasses correction was −0.5Δ/year in the secondary group and −0.2Δ/year in the primary group (P = 0.010). The overall change in spherical equivalent refractive error was −0.2 D/year in the secondary group and −0.3 D/year in the primary group (P < 0.001). The latest stereoacuity result was poorer in the secondary group than in the primary group (P = 0.027). No significant differences in the decompensation or weaning rates were detected between groups.

Conclusions

The changes in refractive error and the amount of esotropia over time were different between the secondary group and the primary group. Although refractive error was significantly lower and stereoacuity was poorer in the secondary group compared to the primary group, the majority of patients in the secondary group maintained good control of ocular alignment after hyperopic correction.

Section snippets

Subjects and Methods

This study was approved by the Institutional Review Board of Samsung Medical Center (Seoul, Republic of Korea). The medical records of patients with esotropia with an accommodative component after surgery for infantile esotropia (secondary group) and patients with primary accommodative esotropia (primary group) examined at Samsung Medical Center between January 1994 and December 2009 were reviewed retrospectively. Patients in the secondary group were considered for inclusion if they developed

Results

Of the 177 patients who underwent strabismus surgery for infantile esotropia during the study period, 79 had hyperopia of ≥ +1.5 D and corrected esotropia of ≤10Δ with full cycloplegic hyperopic correction. Of these 79 patients, 41 met inclusion criteria. In the primary group, 224 patients had hyperopia of ≥ +1.5 D or and corrected esotropia of ≤10Δ with full cycloplegic hyperopic correction. Of these, 101 met inclusion criteria.

The baseline characteristics of the two groups are described in

Discussion

The prevalence of accommodative esotropia among normal children with hyperopia of ≥ +4.0 D during infancy is 10%-20%.12, 13 In this study, 79 patients (45%) developed significant esotropia with an accommodative component, which decreased to <10Δ with hyperopic correction among the 177 patients who underwent strabismus surgery for infantile esotropia. They had a much lower mean initial refractive error than patients with primary accommodative esotropia. Previous studies have reported prevalence

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