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Early-onset refractive accommodative esotropia
D K Coats1, C W Avilla, E A Paysse
1Cullen Eye Institute, Baylor College of Medicine, Texas Children's Hospital, Houston, USA.
Insights
Early-onset refractive accommodative esotropia in infants, diagnosed as young as 4 months, showed no amblyopia and stable alignment with spectacles. Prematurity was identified as a significant risk factor in these young patients.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus
Background:
- Investigating the natural history of pure refractive accommodative esotropia in infants with early onset (before 1 year old).
- Comparing outcomes and characteristics with patients experiencing typical onset of refractive accommodative esotropia.
Purpose of the Study:
- To determine if early-onset refractive accommodative esotropia (before 1 year) differs in outcomes and characteristics from later-onset cases.
- To identify risk factors and long-term prognosis for infantile refractive accommodative esotropia.
Main Methods:
- Retrospective chart review of 17 children with refractive accommodative esotropia onset before 1 year.
- Comparison with a control group of 26 children with onset after 2 years.
- Analysis of diagnostic age, alignment with spectacles, need for surgery, amblyopia development, and prematurity.
Main Results:
- Mean age at diagnosis was 9 months for early-onset vs. 48 months for controls.
- No amblyopia developed in the early-onset group, compared to 42% in controls (P=.001).
- Prematurity was a significant risk factor for early-onset esotropia (47% vs. 12%, P=.03).
Conclusions:
- Refractive accommodative esotropia can be diagnosed as early as 4 months.
- Full hyperopic spectacle correction provides long-term stable alignment with a low need for surgery in early-onset cases.
- Prematurity is a notable risk factor for this condition.
Introduction:
We studied the natural history of pure refractive accommodative esotropia after spectacle correction in patients with onset before 1 year old to determine whether their outcomes and characteristics were different from those of patients with more typical age at onset of refractive accommodative esotropia.
Methods:
We retrospectively reviewed the charts of 17 children with onset of refractive accommodative esotropia before 1 year old. Records of 26 children with onset after 2 years old were reviewed as controls.
Results:
The mean ages at diagnosis were 9 months and 48 months for the study and control groups, respectively. All 17 study patients and all 26 control patients were initially well aligned with spectacles at distance and near. Follow-up averaged 34 months for study patients and 41 months for control patients. Three study patients (17.6%) and 1 control patient (3.8%) had eventual deterioration and required strabismus surgery (P = .28). None of the study patients developed amblyopia, whereas 42% of control patients did (P = .001). Seven of 15 (47%) of the study patients with known birth history were born prematurely, whereas only 3 of 24 (12%) control patients were born prematurely (P = .03).
Conclusions:
Refractive accommodative esotropia was diagnosed at as early as and age 4 months. Prematurity appeared to be a risk factor. Amblyopia was not detected in any patient with early-onset refractive accommodative esotropia. Treatment with full hyperopic spectacle correction led to long-term stable alignment, with relatively few patients requiring surgery.
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