Axial Length as a Risk Factor for Development of Acquired Distance Esotropia
Dana Garzozi, MD; Eran Pras, MD; Yakov Goldich, MD; Yair Morad, MD
Assaf Harofeh Medical Center, Tel Aviv University
Tel Aviv, Israel
Introduction: The aim of this study was to see if patients with acquired distance esotropia (ADE) differ in axial length measurements from other patients with esotropia and normal controls.
Methods: All adult patients operated for esotropia by the senior author during 1/2015-8/2017 were included. Patients with esotropia of at least 5 prism diopters greater for distance than near were included in the ADE group. Other patients with esotropia and patients without strabismus awaiting cataract surgery served as controls. Axial length was measured in all subjects.
Results: ADE, esotropia and cataract groups had 11, 15 and 15 patients respectively. Average age was 44±14 (range 23-69 years), 32±13 (range 16-58 years) and 61±19 (range 23-84 years) respectively. In ADE average esotropia for distance was 17.2±3.8 prism diopters (PD, range 10-25) and 8.18±7 PD for near (range 4-20), while in the esotropia group it was 27±14 PD for distance (range 20-50) and 31±12 PD (range 20-55) for near. ADE patients were significantly more myopic (average -2.11±2.89, range +0.75 to -7.5D) than the esotropia group (average +1.75±2.1, range -1.0 to +6.0) and the cataract group (average +0.75±1.5 range -2.5 to +3.0 p=0.003).
Average axial length in the ADE group was 25.05±1.7mm (range 23.4-29.54), significantly more than the esotropia group (average 22.4±0.8mm, range 21.0-23.3) and the cataract group (average 22.9±0.73mm, range 21.87-24.55, p=0.007).
Discussion: ADE may be caused by downshift of the lateral and nasal shift of the superior rectus muscles. Higher axial length may facilitate this phenomenon.
Conclusion: Patients with ADE have significantly bigger axial length than other patients with esotropia and normal controls. ADE may be a milder version of strabismus fixus seen in highly myopic patients with high axial length (heavy eye syndrome).
References: Morad Y, Pras E, Nemet A.|Superior and Lateral Rectus Myopexy for Acquired Adult Distance Esotropia: A ‘One Size Fits All’ Surgery. Strabismus. 2017 Jul 31:1-5.