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Long-term follow-up of acquired nonaccommodative esotropia in a population-based cohort
Sarah M Jacobs1, Amy Green-Simms, Nancy N Diehl
1Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Insights
Acquired nonaccommodative esotropia (ANAET) affects 1 in 287 children, predominantly males. Early diagnosis and absence of amblyopia correlate with better long-term vision outcomes after surgery.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Research
Background:
- Acquired nonaccommodative esotropia (ANAET) is a form of strabismus in children.
- Understanding its clinical characteristics and long-term outcomes is crucial for effective management.
Purpose of the Study:
- To describe the clinical features and long-term outcomes of pediatric patients diagnosed with ANAET over a 30-year period.
- To determine the incidence and risk factors associated with ANAET.
Main Methods:
- Retrospective population-based cohort study.
- Review of medical records of pediatric residents diagnosed with ANAET between 1965 and 1994.
- Analysis of incidence, clinical characteristics, and motor/sensory outcomes.
Main Results:
- ANAET incidence was 1 in 287 live births, with a median diagnosis age of 4.0 years; males were more prevalent.
- 73% of patients underwent strabismus surgery, with a median final stereoacuity of 3000 seconds of arc.
- Older age at diagnosis (>44 months) and absence of amblyopia were predictive of excellent final stereopsis.
Conclusions:
- ANAET is a relatively common condition in children, more frequent in males.
- While diplopia can occur, serious intracranial pathology is rare.
- Good motor and sensory outcomes are achievable, particularly with later onset and no amblyopia.
Purpose:
To describe the clinical characteristics and long-term outcomes of children diagnosed over a 30-year period with acquired nonaccommodative esotropia (ANAET).
Design:
Retrospective chart review of a population-based cohort.
Participants:
All pediatric (<19 years of age) residents of Olmsted County, Minnesota, who were diagnosed with ANAET from January 1, 1965, to December 31, 1994.
Methods:
The medical records of all potential patients identified by the resources of the Rochester Epidemiology Project were reviewed.
Main Outcome Measures:
Incidence, clinical characteristics, and long-term motor and sensory outcomes of children with ANAET.
Results:
A total of 174 children were diagnosed during the 30-year period, yielding an incidence of 1 in 287 live births. The median age at diagnosis for the 174 patients was 4.0 years (range, 10 months to 18.2 years), and 61% (107) were male (P = 0.009). Although 11% (8/75) of those queried were diplopic, none of the 174 was subsequently diagnosed with an intracranial lesion. During a mean follow-up of 10.9 years (range, 0 days to 37 years), 127 patients (73%) underwent strabismus surgery (mean, 1 surgery; range, 0-3 surgeries). Among the 127 patients who underwent surgery, the median final stereoacuity was 3000 seconds of arc, including 8 patients (6.3%) with ≥ 50 seconds of arc. Patients who were older (>44 months) at ANAET diagnosis (P = 0.005) and without amblyopia at their initial examination (P < 0.001) were more likely to achieve excellent final stereopsis.
Conclusions:
In this population-based cohort, ANAET occurred in 1 in 287 children and was more prevalent among male children. Although diplopia was relatively common, none of the children were found to have an intracranial malignancy. Most patients achieved good motor and sensory outcomes, with the best results among those with a later onset of their deviation and no amblyopia.
Financial Disclosure(S):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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