Clinical Features of Refractive Accommodative Esotropia with Hyperopic Anisometropia

Ho Seok Moon; Hae Jung Paik

doi:10.3341/jkos.2013.54.4.632

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

Original Article

J Korean Ophthalmol Soc 2007;54(4):632-638.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.4.632

Clinical Features of Refractive Accommodative Esotropia with Hyperopic Anisometropia

Ho Seok Moon, MD, Hae Jung Paik, MD, PhD

Department of Ophthalmology, Gachon University, Gil Medical Center, Incheon, Korea

Address reprint requests to Hae Jung Paik, MD, PhD Department of Ophthalmology, Gachon University Gil Medical Center #21 Namdong-daero 774beon-gil, Incheon 405-760, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358, E-mail: hjpaik@gilhospital.com

Received 22 June 201226 September 2012 Accepted 15 February 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

Keywords: Amblyopia, Anisometropia, Hyperopia, Refractive accommodative esotropia

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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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