Long-term follow-up of acquired nonaccommodative esotropia in a population-based cohort

Abstract

Purpose: To describe the clinical characteristics and long-term outcomes of children diagnosed over a 30-year period with acquired nonaccommodative esotropia (ANAET).

Design: Retrospective chart review of a population-based cohort.

Participants: All pediatric (<19 years of age) residents of Olmsted County, Minnesota, who were diagnosed with ANAET from January 1, 1965, to December 31, 1994.

Methods: The medical records of all potential patients identified by the resources of the Rochester Epidemiology Project were reviewed.

Main outcome measures: Incidence, clinical characteristics, and long-term motor and sensory outcomes of children with ANAET.

Results: A total of 174 children were diagnosed during the 30-year period, yielding an incidence of 1 in 287 live births. The median age at diagnosis for the 174 patients was 4.0 years (range, 10 months to 18.2 years), and 61% (107) were male (P = 0.009). Although 11% (8/75) of those queried were diplopic, none of the 174 was subsequently diagnosed with an intracranial lesion. During a mean follow-up of 10.9 years (range, 0 days to 37 years), 127 patients (73%) underwent strabismus surgery (mean, 1 surgery; range, 0-3 surgeries). Among the 127 patients who underwent surgery, the median final stereoacuity was 3000 seconds of arc, including 8 patients (6.3%) with ≥ 50 seconds of arc. Patients who were older (>44 months) at ANAET diagnosis (P = 0.005) and without amblyopia at their initial examination (P < 0.001) were more likely to achieve excellent final stereopsis.

Conclusions: In this population-based cohort, ANAET occurred in 1 in 287 children and was more prevalent among male children. Although diplopia was relatively common, none of the children were found to have an intracranial malignancy. Most patients achieved good motor and sensory outcomes, with the best results among those with a later onset of their deviation and no amblyopia.

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.