Session: Free papers Session I - Esotropia 1

Incidence and risk factors for development of consecutive exotropia during management of fully accommodative esotropia with optical correction

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INTRODUCTION: Children with fully accommodative esotropia who initially respond to optical correction may develop consecutive exotropia during their follow-up. The purpose of this study is to identify the incidence and risk factors for development of non-surgical consecutive exodeviation.

METHODS: A retrospective chart review was performed of all children with a  diagnosis of fully accommodative esotropia and a minimum follow-up of 3 years after initial prescription of spectacles. The age at onset of esotropia, the age of initiation of spectacles, the initial best-corrected visual acuity (BCVA), the initial and final refractive errors, the presence of amblyopia, angles of deviation, and stereoacuity were recorded and tabulated. Patients who developed consecutive exodeviation during follow-up were analyzed.

RESULTS: A total of 178 children were identified. The mean age at presentation and at prescription of spectacles was 2.3 ±1.4 years and 2.9 ± 1.5 years respectively. The mean spherical equivalent was +4.3 ± 1.8 D. The mean follow-up was 6.9 ± 3.7 years. Consecutive exodeviation developed in 31 children (17.4%), mean time to development was 3.5 ± 3.6 years after prescription of spectacles. Children who developed consecutive exotropia had a higher prevalence of amblyopia (P < 0.001), higher initial spherical error (P= 0.024), higher initial cylindrical error (P=0.009), higher initial spherical equivalent (P =0.004), higher prevalence of coexisting vertical deviations (P <0.001) and neurological problems (P=0.0374). There was no statistically significant difference between both groups regarding the age of onset, the age of initiation of spectacles, angles of deviation.

CONCLUSIONS: Children with fully accommodative esotropia are at risk of development of consecutive exotropia, especially if they present with a higher refractive error, amblyopia, or a coexisting vertical deviation. Careful follow-up is needed to identify these children and manage them promptly.