Journal List > J Korean Ophthalmol Soc > v.54(4) > 1009651

Moon and Paik: Clinical Features of Refractive Accommodative Esotropia with Hyperopic Anisometropia

Abstract

Purpose

To investigate the clinical features of refractive accommodative esotropia with hyperopic anisometropia. Methods: Retrospective chart review was performed for 71 patients with refractive accommodative esotropia and hyper-opic anisometropia. Patients were divided into isometropia and anisometropia groups, as well as disappeared anisometropia and maintained anisometropia groups. Clinical features such as amblyopia, stereopsis, decompensation, and cessation of spectacle use were reviewed.

Results

Anisometropia was found in 14 patients (19.7%). Amblyopia was detected in 35% of the patients in the isometropia group and 67% of the patients in the anisometropia group on the first visit (p = 0.048), but improved to 14% in the isometropia group and 21% in the anisometropia group on the final visit. Good stereopsis was reported in 28% of the patients in the isometropia group and 21% of the patients in the anisometropia group on the first visit, and improved to 67% in the isometropia group and 79% in the anisometropia group on the final visit. There were no differences of prevalence of decompensation and cessation of spectacle use between the 2 groups. Cases with disappeared anisometropia on the final visit were observed in 42.9% of the patients. Disappearance of anisometropia was not related with amblyopia, stereopsis, decompensation, and cessation of spectacle use.

Conclusions

Although refractive accommodative esotropia accompanied by anisometropia has a greater chance to show amblyopia on the initial visit, good prognosis can be expected when the patients are carefully managed with hyperopic correction and occlusion therapy.
J Korean Ophthalmol Soc 2013;54(4):632-638

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Table 1.
Refractive errors of control and anisometropia group at initial visit
Control (n = 57) Anisometropia (n = 14) p-value*
Spherical (D) Higher eye 5.06 ± 2.18 6.43 ± 1.44 0.033
Lower eye 4.73 ± 2.16 3.93 ± 1.38 0.235
Difference 0.33 ± 0.44 2.50 ± 0.46 <0.0001
Cylinder (D) Higher eye 0.90 ± 0.75 1.39 ± 0.45 0.004
Lower eye 0.71 ± 0.70 1.02 ± 0.63 0.089
Difference 0.19 ± 0.22 0.36 ± 0.38 0.170
SE (D) Higher eye 5.51 ± 2.26 7.13 ± 1.42 0.013
Lower eye 5.09 ± 2.26 4.44 ± 1.44 0.342
Difference 0.43 ± 0.49 2.68 ± 0.53 <0.0001

Values are presented as mean ± SD.

D = diopters; SE = spherical equivalent.

* Mann-Whitney U-test.

Table 2.
Clinical characteristics of control and anisometropia group
Initial visit Final visit
Control (n = 57) Anisometropia (n = 14) p-value Control (n = 57) Anisometropia (n = 14) p-value
Sex (M:F) 24 : 33 10 : 4
Age at onset of esodeviation (month) 36.6 ± 18.6 30.9 ± 19.2 0.369
Age at initial visit (month) 46.8 ± 17.8 42.3 ± 20.9 0.430
Duration of misalignment (month) 11.5 ± 9.1 10.2 ± 6.7 0.852
Deviation at distance (PD) 22.8 ± 9.9 30.4 ± 14.0 0.141 19.5 ± 15.7 21.8 ± 13.9 0.637
Deviation at near (PD) 24.7 ± 12.6 31.6 ± 14.3 0.141 20.1 ± 16.0 22.3 ± 14.2 0.670
Controlled deviation at distance (PD) 1.4 ± 3.0 2.2 ± 4.0 0.495 0.2 ± 0.6 2.0 ± 3.7 0.165
Controlled deviation at near (PD) 1.6 ± 4.5 3.3 ± 4.6 0.185 0.6 ± 1.6 2.6 ± 4.5 0.172
Good stereopsis* 28% (13/46) 21% (3/14) 0.739* 67% (34/51) 79% (11/14) 0.517*
Amblyopia 33% (15/46) 64% (9/14) 0.033* 14% (7/51) 21% (3/14) 0.681*
Oblique dysfunction 13% (6/48) 14% (2/14) 1.000*
Decompensation 18% (10/57) 7% (1/14) 0.429*
Cessation of spectacles 18% (10/57) 21% (3/14) 1.000*

Values are presented as mean ± SD.

PD = prism diopters.

* Stereopsis more than 100 seconds by Titmus test or fusion at near and distant by Worth 4 dot test; Mann-Whitney U test; *Fisher's exact test.

Table 3.
Refractive errors of anisometropia disappeared and maintained group
Initial visit Final visit
Disappeared (n = 6) Maintained (n = 8) p-value* Disappeared (n = 6) Maintained (n = 8) p-value*
Spherical (D) Higher eye 6.79 ± 1.49 6.00 ± 1.41 0.552 5.17 ± 1.45 5.90 ± 1.70 0.303
Lower eye 4.04 ± 1.42 3.80 ± 1.48 0.900 4.13 ± 1.58 3.10 ± 1.79 0.355
Difference 2.75 ± 0.32 2.20 ± 0.45 0.073 1.04 ± 0.58 2.80 ± 0.57 0.004
Cylinder (D) Higher eye 1.29 ± 0.43 1.50 ± 0.50 0.563 1.46 ± 1.02 1.85 ± 0.74 0.424
Lower eye 0.75 ± 0.67 1.35 ± 0.42 0.061 1.21 ± 0.89 1.15 ± 0.68 0.881
Difference 0.54 ± 0.40 0.15 ± 0.22 0.132 0.25 ± 0.16 0.70 ± 0.41 0.084
SE (D*) Higher eye 7.44 ± 1.46 6.75 ± 1.44 0.444 5.90 ± 1.72 6.83 ± 1.91 0.400
Lower eye 4.42 ± 1.44 4.48 ± 1.61 0.972 4.73 ± 1.68 3.68 ± 2.04 0.429
Difference 3.02 ± 0.36 2.28 ± 0.42 0.022 1.17 ± 0.64 3.15 ± 0.76 0.006

Values are presented as mean ± SD.

D = diopters; SE = spherical equivalent.

* Mann-Whitney U-test.

Table 4.
Refractive changes per year of aniso disappeared and maintained group
Disappeared (n = 6) Maintained (n = 8) p-value*
Spherical (D/year) Higher eye -0.29 ± 0.34 -0.01 ± 0.05 0.030
Lower eye +0.01 ± 0.35 -0.10 ± 0.10 0.177
Cylinder (D/year) Higher eye +0.03 ± 0.14 +0.05 ± 0.07 0.792
Lower eye +0.08 ± 0.07 -0.03 ± 0.06 0.052
SE (D/year) Higher eye -0.27 ± 0.37 +0.01 ± 0.08 0.082
Lower eye +0.05 ± 0.36 -0.11 ± 0.11 0.082

Values are presented as mean ± SD.

D = diopters; SE = spherical equivalent.

* Mann-Whitney U-test.

Table 5.
Clinical characteristics of aniso disappeared and maintained group
Initial visit Final visit
Disappeared (n = 6) Maintained (n = 8) p-value Disappeared (n = 6) Maintained (n = 8) p-value
Sex (M:F) 4 : 2 6 : 2
Age at onset of esodeviation (month) 38.5 ± 23.1 34.4 ± 13.5 0.792
Age at initial visit (month) 48.8 ± 23.0 44.4 ± 11.1 0.537
Duration of misalignment (month) 10.3 ± 7.2 10.0 ± 6.8 0.931
Deviation at distance (PD) 22.50 ± 9.87 23.20 ± 11.17 0.792 22.67 ± 16.78 15.60 ± 15.06 0.537
Deviation at near (PD) 22.50 ± 9.87 27.40 ± 16.13 0.793 22.17 ± 15.93 17.60 ± 17.50 0.931
Controlled deviation at distance (PD) 1.17 ± 2.86 1.60 ± 3.58 0.931 0.33 ± 0.82 0.93 ± 1.83 0.862
Controlled deviation at near (PD) 1.50 ± 3.67 1.60 ± 3.58 0.958 0.33 ± 0.82 1.00 ± 2.24 0.931
Good stereopsis* 17% (1/6) 25% (2/8) 1.000* 67% (4/6) 87% (7/8) 0.538*
Amblyopia 50% (3/6) 75% (6/8) 0.580* 33% (2/6) 13% (1/8) 0.538*
Oblique dysfunction 17% (1/6) 13% (1/8) 1.000*
Decompensation 0% (0/6) 13% (1/8) 1.000*
Cessation of spectacles 17% (1/6) 13% (1/8) 1.000*

Values are presented as mean ± SD.

PD = prism diopters.

* Stereopsis more than 100 seconds by Titmus test or fusion at near and distant by Worth 4 dot test; Mann-Whitney U test; *Fisher's exact test.

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