Predictors of nonsurgical consecutive exotropia following accommodative esotropia

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos Pub Date : 2025-12-01 Epub Date: 2025-11-21 DOI:10.1016/j.jaapos.2025.104695

Hala ElHilali MD, Ahmed Awadein MD, Rokaya Radwan MD, Jylan Gouda MD, Heba M. Fouad MD

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引用次数: 0

Abstract

Purpose

To identify the incidence of and risk factors for development of spontaneous consecutive exotropia during management of fully accommodative esotropia with optical correction.

Methods

The medical records of patients who presented with an initial diagnosis of fully accommodative esotropia and converted to exotropia during their management were reviewed retrospectively. Patients with a minimum of 3 years’ follow-up were included. The following data were extracted from the record: age of onset, refractive error, glasses prescription, angles of deviation, visual acuity, and stereoacuity.

Results

A total of 178 children with fully accommodative esotropia were identified. Mean age of esotropia onset was 2.3 ±1.4 years; of initial glasses prescription, 2.9 ± 1.5 years. We calculated the mean spherical equivalent by averaging the values of both eyes for each patient. Mean spherical equivalent of both eyes was +4.3 ± 1.8 D. The mean follow-up was 6.9 ± 3.7 years. Consecutive exotropia developed in 31 children (17.4%) at a mean of 3.5 ± 3.6 years after prescription of spectacles. Children who developed consecutive exotropia had a higher initial spherical error (P = 0.02), higher initial cylindrical error (P = 0.01), and higher prevalence of neurological problems (P = 0.01) on multivariable analysis. Higher prevalence of amblyopia (P < 0.001) and vertical deviation (P < 0.001) were detected in the spontaneous exodeviation group on univariate analysis only. There was no statistically significant difference between spontaneous exotropia following accommodative esotropia and accommodative esotropia groups as a whole in terms of age of onset, the age of initiation of spectacles, angles of deviation, stereoacuity, or the time of initiation of reduction of hyperopic prescription.

Conclusions

High hyperopia (≥5 D), high astigmatic errors (≥1.5 D), and presence of neurological problems are risk factors for development of spontaneous exotropia among accommodative esotropia patients. Long-term follow-up is recommended for patients who have identifiable risk factors.

查看原文本刊更多论文

适应性内斜视后非手术性连续外斜视的预测因素。

目的：探讨光学矫正治疗全适应性内斜视过程中自发性连续外斜视的发生率及危险因素。方法：回顾性分析初诊为完全调节性内斜视而在治疗过程中转为外斜视的患者病历。随访时间至少为3年的患者纳入研究。从记录中提取以下数据：发病年龄、屈光不正、眼镜处方、偏差角、视力和立体视力。结果：共发现178例完全调节性内斜视患儿。内斜视发病平均年龄为2.3±1.4岁；初次配镜者，2.9±1.5年。我们通过平均每位患者双眼的值来计算平均球面等效。双眼平均球当量为+4.3±1.8 d，平均随访时间为6.9±3.7年。31例（17.4%）儿童配戴眼镜后平均3.5±3.6年出现连续外斜视。多变量分析结果显示，连续外斜视患儿初始球面误差较高（P = 0.02），初始圆柱误差较高（P = 0.01），神经系统疾病患病率较高（P = 0.01）。在单变量分析中，自发性外偏组的弱视患病率（P < 0.001）和垂直偏差（P < 0.001）较高。调节性内斜视后自发性外斜视与整体调节性内斜视组在发病年龄、配戴眼镜年龄、偏度角、立体视敏度、远视处方开始复位时间等方面无统计学差异。结论：高度远视（≥5d）、高度散光误差（≥1.5 D）和存在神经系统问题是调节性内斜视患者发生自发性外斜视的危险因素。对于有明确危险因素的患者，建议进行长期随访。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Aapos 医学-小儿科

CiteScore

2.40

自引率

12.50%

发文量

159

审稿时长

55 days

期刊介绍： Journal of AAPOS presents expert information on children''s eye diseases and on strabismus as it affects all age groups. Major articles by leading experts in the field cover clinical and investigative studies, treatments, case reports, surgical techniques, descriptions of instrumentation, current concept reviews, and new diagnostic techniques. The Journal is the official publication of the American Association for Pediatric Ophthalmology and Strabismus.