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Kim and Rah: Clinical Characteristics of Exodeviated Patients with Accomodative Esotropia and Hyperopia without Strabismus
Original Article

J Korean Ophthalmol Soc 2015;56(12):1921-1925.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.12.1921

Clinical Characteristics of Exodeviated Patients with Accomodative Esotropia and Hyperopia without Strabismus

Soo Han Kim, M.D, Sang Hoon Rah, M.D

Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea

Address reprint requests to Sang Hoon Rah, MD Department of Ophthalmology, Wonju Severance Christian Hospital, #20 Ilsan-ro, Wonju 26426, Korea Tel: 82-33-741-1346, Fax: 82-33-742-3245 E-mail: shrah@yonsei.ac.kr

Received 12 February 201518 August 2015       Accepted 1 October 2015

Copyright © 2015 Korean Ophthalmological Society

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 evaluate the clinical characteristics of exodeviated patients with accomodative esotropia and orthophoric hyperopia.

Methods

We conducted a retrospective chart review of patients with accommodative esotropia and hyperopia who later devel-oped exotropia and visited the Department of Ophthalmology of Wonju Severance Christian Hospital from January 1, 1997 to December 31, 2013.

Results

The study included 13 patients with a mean age of 4.1 years at initial referral. At the initial visit, nine patients (69.2%) had accommodative esotropia with a median of 25.5 PD esotropia at near gaze. Among the esotropic patients, four patients (44.4%) had unilateral amblyopia and five patients (55.6%) had bilateral amblyopia. The spherical equivalent was +6.09 D in the amblyopic eye and +5.63 D in the dominant eye. In the cases of bilateral amblyopia, the spherical equivalent was +5.875 D. Spontaneous consecutive exotropia developed at a mean age of 8.63 years (average follow-up of 56.38 months). Mean exodevia-tion was 10.33 PD. Among the four patients (30.8%) who were orthophoric at their initial visit, two patients (50%) had unilateral am-blyopia and two (50%) had bilateral amblyopia. The spherical equivalents of the amblyopic eye and the dominant eye were +5.63 D and +3.13 D, respectively. In cases of bilateral amblyopia, a mean spherical equivalent of +5.50 D was observed. The mean age when exodeviation occurred was 10.75 years, which was 64 months after the initial visit. The average exodeviation was 6.5 PD.

Conclusions

When treating accommodative esotropia and hyperopia, long-term observation is necessary since exodeviation could develop. Exotropia was successfully managed with spectacle correction. Further studies are needed for possible surgical intervention.

Keywords: Accommodative esotropia, Exotropia, Hyperopia, Spectacle correction, Spontaneous consecutive exotropia

References

1. Beneish R, Williams F, Polomeno RC, Little JM. Consecutive exo-tropia after correction of hyperopia. Can J Ophthalmol. 1981; 16:16–8.
2. Kim MJ, Jin YH. Spontaneous consecutive exotropia. J Korean Ophthalmol Soc. 1999; 40:2918–22.
3. Swan KC. Accommodative esotropia long range follow-up. Ophthalmology. 1983; 90:1141–5.
crossref
4. Weir CR, Cleary M, Dutton GN. Spontaneous consecutive extropia in children with motor fusion. Br J Ophthalmol. 2001; 85:242–3.
5. Ingram RM, Barr A. Changes in refraction between the ages of 1 and 3 1/2 years. Br J Ophthalmol. 1979; 63:339–42.
crossref
6. Chung SA, Kim IS, Kim WK, Lee JB. Changes in exodeviation fol-lowing hyperopic correction in patients with intermittent exotropia. J Pediatr Ophthalmol Strabismus. 2011; 48:278–84.
crossref
7. Iacobucci IL, Archer SM, Giles CL. Children with exotropia re-sponsive to spectacle correction of hyperopia. Am J Ophthalmol. 1993; 116:79–83.
crossref
8. Kassem IS, Rubin SE, Kodsi SR. Exotropia in children with high hyperopia. J AAPOS. 2012; 16:437–40.
crossref
9. Youm DJ, Chang HR. Long-term binocularity in accommodative esotropia. J Korean Ophthalmol Soc. 2015; 56:759–63.
crossref
10. Kim MM, Cho YJ. The factors influencing on binocularity in ac-commodative esotropia. J Korean Ophthalmol Soc. 1997; 38:1847–51.

Table 1.
Clinical characteristics of exodeviated patients from accomodative esotropia
Initial
 Onset of exotropia
Age*(months) BCVA SE PD Age* (months) BCVA SE PD/c glc† Change in SE PD/c altered glc‡( F/U (months) Last PD§) Stereopsis
1 OD 57 0.3 +3.00 20 ET 92 0.6 +3.25 15 XT -1.00 F) Small X 41 F) Ortho 200 sec
OS 0.7 +2.00 0.9 +2.00 -1.00 N) 4 X N) 8 XT N) F) OD supression
2 OD 39 N/A +3.50 35 ET 109 1.0 +2.25 Small X -0.50 F) Ortho 15 F) 4 XT 200 sec
OS N/A +3.50 1.0 +2.50 -0.50 N) 4 X N) 10 XT F) Diplopia
N) Fusion
3 OD 54 0.4 +5.50 20 ET 93 0.7 +4.00 12 X -1.50 F) 6X 72 F) 15 XT 140 sec
OS 0.4 +5.75 0.6 +4.00 -1.75 N) F) Diplopia
4 OD 34 N/A +6.00 20 ET 73 0.2 +5.00 Small X -1.00 F) Small X 27 F) Small X 400 sec
OS N/A +6.00 0.2 +5.00 -1.00 N/A
5 OD 64 0.2 +7.88 30 ET 93 0.6 +6.00 16 XT -1.50 F) 8 X 101 F) 8 X 400 sec
OS 0.8 +7.88 0.9 +5.25 -1.50 N) F) Fusion
6 OD 40 0.025 +7.00 F) 18 ET 170 1.0 +2.13 10 XT -1.00 F) Ortho 13 F) Ortho 800 sec
OS 0.4 +6.25 N) 20 ET 1.0 +1.00 -1.00 N) Ortho N) Ortho N) F) OD supression
7 OD 54 N/A +6.38 30 ET 158 0.7 +2.63 14 XT -1.00 F) 8 X 98 F) 14 XT 400 sec
OS N/A +6.50 0.6 +3.00 -1.00 N) Fusion
F) Intermittent
diplopia
8 OD 70 0.5 +5.38 F) 25 ET 79 0.6 +4.38 14 XT -1.00 F) 10 ET N/A N/A N/A
OS 0.4 +5.38 N) 20 ET 0.6 +4.88 -1.00 N/A
9 OD 49 N/A +8.88 F) 35 ET 89 0.7 +8.38 12 XT -1.00 F) Small ET 84 F) Small E 800 sec
OS N/A +8.88 N) 35 ET 0.7 +7.75 -1.00 N) 6 ET N) Fusion
F) Diplopia

BCVA = best corrected visual acuity; SE = spherical equivalent; PD = prism diopter of deviation; F/U = follow up; OD = oculus dexter; OS = oculus sinister; N/A = not available; ET = esotropia; F = far; N = near; XT = exotropia; X = exophoria; Ortho = orthophoria; sec = seconds.* Patient’s age in months; † Prism diopter of deviation with full correction glasses; ‡ Prism diopter of deviation with altered glasses; § Prism diop-ter of deviation on last follow-up.

Table 2.
Clinical characteristics of exodeviated patients from hyperopia
Initial Onset of Exotropia
1 ( OD Age* (months) 93 BCVA 0.3 SE +5.75 PD Ortho Age*(months) 135 BCVA 1.0 SE +4.38 PD/c glc† 14 XT Change in SE -1.50 PD/c altered glc‡ F) Ortho F/U (months 19 Last PD§) F) Ortho Stereopsis 400 sec
OS 0.4 +6.25 1.0 +2.75 -1.50 N) 6 X N) F) Fusion
2 OD 98 0.5 +5.25 Ortho 171 1.0 +3.25 12 XT None F) 12 XT 14 F) 14 XT 400 sec
OS 0.9 +1.25 1.0 ‒ 0.75 None N) F) OD
suppression
3 OD 35 0.4 +6.00 Ortho 147 0.7 +4.00 Small X -1.00 F) Ortho 30 F) Ortho 400 sec
OS 0.2 +5.00 0.7 +2.88 -1.00 N) 6 XT N) F) Fusion
4 OD 45 0.2 +5.00 Ortho 76 1.0 +3.50 Small X -1.00 Small ET 84 F) 8X 200 sec
OS 0.1 +5.00 1.0 +4.25 -1.00 N) 12 X N) F) Fusion

BCVA = best corrected visual acuity; SE = spherical equivalent; PD = prism diopter of deviation; F/U = follow up; OD = oculus dexter; OS = oculus sinister; Ortho = orthophoria; XT = exotropia; F = far; N = near; X = exophoria; ET = esotropia; sec = seconds.* Patient’s age in months; † Prism diopter of deviation with full correction glasses; ‡ Prism diopter of deviation with altered glasses; § Prism diop-ter of deviation on last follow-up.

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