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Untreated essential infantile esotropia: factors affecting the development of amblyopia
1Department of Ophthalmology, Charing Cross Hospital, Fulham Palace Road London, UK.
Insights
Essential infantile esotropia can lead to amblyopia, especially with anisometropia. Delaying surgery until adulthood may preserve visual acuity in some patients without significant refractive errors.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus
Background:
- Essential infantile esotropia is a condition presenting in early infancy.
- It is often associated with dissociated vertical deviation, manifest latent nystagmus, and asymmetric optokinetic nystagmus.
- Most research focuses on early diagnosis and childhood treatment.
Purpose of the Study:
- To investigate factors influencing amblyopia development in essential infantile esotropia patients.
- To analyze outcomes in patients with essential infantile esotropia not treated until visual adulthood.
Main Methods:
- A cohort of 113 patients aged 8+ years with infantile-onset esotropia was studied over 3 years.
- All patients underwent ocular motility assessment and cycloplegic refraction.
- Inclusion criteria required at least one sign of essential infantile esotropia.
Main Results:
- Amblyopia was diagnosed in 16% of patients (14.3% visual acuity difference).
- Anisometropia was present in 62.5% of amblyopic patients.
- A statistically significant correlation was found between anisometropia and amblyopia (p=0.0001).
Conclusions:
- While early surgery for infantile esotropia has risks, it offers potential for binocular vision.
- For patients lacking access to continuous therapy, delaying surgery until adulthood may be beneficial.
- Essential infantile esotropia patients without anisometropia and with free alternation may retain good visual acuity if surgery is postponed.
Purpose:
A concomitant esotropia, presenting within the first 6 months of life, associated with a high incidence of dissociated vertical deviation, manifest latent nystagmus and asymmetric optokinetic nystagmus is termed essential infantile esotropia. Most studies concern patients diagnosed in infancy and treated throughout childhood. This paper addresses the factors that may influence the development of amblyopia in patients who remain untreated until visual adulthood.
Methods:
During a 3 year period 113 patients aged 8 years or more with a history of esotropia occurring within the first 6 months of life were examined for the study. All patients underwent full ocular motility assessment and cycloplegic refraction, and only those with one or more signs of essential infantile esotropia were included.
Results:
Of the 113 patients, 16 (14.3%) had a difference of 2 or more lines in the visual acuity of the two eyes and were diagnosed as having amblyopia. Anisometropia was present in 10 of the 16 (62.5%). The correlation between anisometropia and amblyopia was statistically significant (p = 0.0001).
Conclusions:
Amblyopia following early surgical intervention in essential infantile exotropia is well documented, but the risk is outweighed by the chance of obtaining some form of binocular vision. However, where access to ongoing therapy is not available, patients with essential infantile esotropia, free alternation and no anisometropia have a significant chance of retaining good visual acuity in both eyes if surgery is delayed until visual adulthood.