Early-onset refractive accommodative esotropia.
BACKGROUND
We studied the natural history of pure refractive accommodative esotropia after spectacle correction in patients with onset before 1 year old to determine whether their outcomes and characteristics were different from those of patients with more typical age at onset of refractive accommodative esotropia.


METHODS
We retrospectively reviewed the charts of 17 children with onset of refractive accommodative esotropia before 1 year old. Records of 26 children with onset after 2 years old were reviewed as controls.


RESULTS
The mean ages at diagnosis were 9 months and 48 months for the study and control groups, respectively. All 17 study patients and all 26 control patients were initially well aligned with spectacles at distance and near. Follow-up averaged 34 months for study patients and 41 months for control patients. Three study patients (17.6%) and 1 control patient (3.8%) had eventual deterioration and required strabismus surgery (P = .28). None of the study patients developed amblyopia, whereas 42% of control patients did (P = .001). Seven of 15 (47%) of the study patients with known birth history were born prematurely, whereas only 3 of 24 (12%) control patients were born prematurely (P = .03).


CONCLUSIONS
Refractive accommodative esotropia was diagnosed at as early as and age 4 months. Prematurity appeared to be a risk factor. Amblyopia was not detected in any patient with early-onset refractive accommodative esotropia. Treatment with full hyperopic spectacle correction led to long-term stable alignment, with relatively few patients requiring surgery.
Coats
D K
DK
Cullen Eye Institute, Baylor College of Medicine, Texas Children's Hospital, Houston, USA.
Avilla
C W
CW
Paysse
E A
EA
Sprunger
D T
DT
Steinkuller
P G
PG
Somaiya
M
M
D000065:Accommodation, Ocular; D017668:Age of Onset; D002675:Child, Preschool; D003867:Depth Perception; D004948:Esotropia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005139:Eyeglasses; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012008:Recurrence; D012029:Refraction, Ocular; D012030:Refractive Errors / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014787:Vision Tests; D014792:Visual Acuity