Abstract

Volume.124 Number.12

Original article : Clinical science

Preoperative Factors Affecting Outcome after Surgery of Partially Accommodative Esotropia
Yumi Suzuki1, Tadahiro Mitsukawa1, Yukiko Hama1,2, Akane Tomita1, Masakazu Yamada1
1 Department of Ophthalmology, Kyorin University, School of Medicine
2 Nihonbashi Hama Eye Clinic

Purpose: To investigate preoperative factors affecting postoperative ocular alignment and stereoscopic vision after surgery for partially accommodative esotropia.
Materials and methods: The subjects include 35 patients who had previously received a diagnosis of partially refractive accommodative esotropia and undergone postoperative follow-up for at least 1 year from April 2009 to July 2017. The preoperative factors were age at onset of constant esodeviation, age at initial examination, duration of constant ocular misalignment, initial cycloplegic refraction value (spherical equivalent), presence of anisometropia, degree of change in hyperopia, preoperative angles of deviation for near and distance, age at time of surgery, and presence of complications: inferior oblique muscle (IO) overaction or dissociated vertical deviation (DVD). At final postoperative examination using single prism cover test (SPCT), patients with near and distance fixation<10 prism diopters [PD] were assigned to the good alignment group; those with angles of deviation using SPCT for near and distance ≥ 10 PD esotropia were placed in the esotropia group; and those with angles of deviation using SPCT for near and distance ≥ 10 PD exotropia were placed in the exotropia group. Using the Titmus stereo test and a synoptophore, patients with postoperative binocular vision of fly (+) (below 3000s) and SV (+) were assigned to the stereoscopic vision (+) group, and those with other different results were assigned to the stereoscopic vision (-) group. Subsequently, the preoperative factors of the groups were compared.
Results: The age at the onset of constant esodeviation in the good alignment (n=17), esotropia (n=13), and exotropia (n=5) groups were 28.7±13.5, 17.0±10.8, and 11.4±7.0 months, respectively, indicating that the ages at onset in the esotropia and exotropia groups were significantly lower than those in the good alignment group (Mann-Whitney's U-test, p=0.03 and p=0.02, respectively). The mean ages at the onset in the stereoscopic (+) (n=16) and stereoscopic (-) (n=19) groups were 30.4±13.0 and 14.7±9.4 months, respectively, indicating a significantly lower age of onset in the stereoscopic vision (-) group (p<0.01). IO overaction or DVD complication were significantly more common in the exotropia and stereoscopic vision (-) groups (p<0.01). Multivariate logistic regression analysis demonstrated the age of onset to be the only predictive factor to achieve better postoperative stereopsis and good ocular alignment.
Conclusion: Thus, the early onset of esotropia is a preoperative predictive factor of postoperative ocular malalignment and poor stereoscopic vision in patients who undergo operative treatment for partially accommodative esotropia.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 124: 987-994, 2020.

Key words
Partially accommodative esotropia, Lnfantile esotropia, Early-onset accommodative esotropia, Stereopsis, Postoperative ocular alignment
Reprint requests to
Yumi Suzuki, M. D., Ph. D. Department of Ophthalmology, Kyorin University School of Medicine. 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan