Characteristics and Surgical Outcomes of Acquired Nonaccommodative Comitant Esotropia with Diplopia in Children and Young Adults with Different Functional Prognoses
Noriko Nishikawa, MD; Yuriya Kawaguchi, MD; Ikuko Yamaga, CO; Kunihiko Yamada, CO; Yukari Tanaka, CO; Seina Honda, CO; Akitoshi Yoshida, MD, PhD
Asahikawa Medical University
Asahikawa, Hokkaido, Japan
Introduction: Acquired nonaccommodative comitant esotropia (ANAET) with diplopia can be a diagnostic challenge because of its association with neurological abnormalities and difficulty in estimating the accurate time of onset and functional prognosis. We aimed to describe the clinical characteristics and surgical outcomes of ANAET with diplopia in children and young adults and to classify them into esotropia types based on postoperative binocularity.
Methods: Twenty patients with ANAET with diplopia who had undergone strabismus surgery were retrospectively investigated.
Results: The mean (SD) age at awareness of diplopia was 14.0 (6.7) years, and the duration from onset to presentation ranged from 1 day to 12 years. Neurological evaluations were normal in all patients except 2, who refused the examination. Of the 20 patients, 18 were aligned within 8 prism diopters (PD) esotropia or 20 PD esophoria postoperatively. Six (30%) were diagnosed as type 3 (Bielshowsky) acute acquired concomitant esotropia (AACE) with good postoperative stereopsis (Titmus test ≥50 arcsec), and 6 (30%) were type 2 (Franceschetti) AACE with good-to-moderate stereopsis (40–400 arcsec). The remaining 8 (40%) patients were diagnosed with decompensated esodeviation or monofixation syndrome with some level of stereopsis (40–3000 arcsec); 6 of them exhibited unstable normal or abnormal retinal correspondence on the Bagolini striated glass test at the prism-adapted angle and underwent additional sensory testing (Worth 4-dot and/or synoptophore) preoperatively.
Discussion: Of the patients with ANAET with diplopia, only about half could obtain good central foveal stereopsis postoperatively.
Conclusion: Careful preoperative assessment of the sensory status might allow for predicting postoperative binocularity.
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