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Early-onset accommodative esotropia
Insights
Early-onset esotropia in infants, diagnosed before 12 months, often initially responds to anti-accommodative therapy. However, about half may progress to non-accommodative esotropia requiring surgery.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
Background:
- Esotropia is a common strabismus in children.
- Early-onset esotropia presents unique challenges in management.
Purpose of the Study:
- To evaluate the efficacy of anti-accommodative therapy for esotropia diagnosed before 12 months of age.
- To compare clinical findings in early-onset esotropia with later-onset accommodative esotropia.
Main Methods:
- Retrospective analysis of 21 patients with esotropia diagnosed before 12 months.
- Treatment included full hypermetropic spectacles or miotics, or both.
- Comparison with a larger cohort of patients with later-onset accommodative esotropia.
Main Results:
- Initial elimination of esotropia was achieved in all patients with anti-accommodative therapy.
- Approximately 50% of patients progressed to non-accommodative esotropia requiring surgery.
- Most surgically treated patients required continued spectacle wear postoperatively.
Conclusions:
- While anti-accommodative therapy is effective initially for early-onset esotropia, a significant proportion may require surgery.
- Long-term management, including spectacle correction, is often necessary even after surgical intervention.
Abstract:
Twenty-one patients had esotropia diagnosed before age 12 months. In all of these patients esotropia was eliminated, at least initially, by antiaccommodative therapy consisting of either full hypermetropic spectacles or miotics, or both. Clinical findings evaluated in these patients were comparable to similar clinical factors studied in a larger series of patients with accommodative esotropia, most with onset after 12 months of age. In approximately 50% of these patients early-onset accommodative esotropia deteriorated to a nonaccommodative esotropia that required surgery despite aggressive antiaccommodative therapy. All but one of the surgically treated patients continued to need hypermetropia spectacles postoperatively to maintain alignment.