Journal of Pediatric ophthalmology & strabismus

Assessment of Refractive Error Changes and Factors for Decompensation in Patients With Fully Accommodative Esotropia

Selcen Çelik, MD; Osman Bulut Ocak, MD; Aslı İnal, MD; Ebru Demet Aygıt, MD; Ceren Gürez, MD; Zahid Hüseyinhan, MD; Birsen Gökyiğit, MD

Abstract

PURPOSE:

To determine the factors affecting the risk of deterioration and evaluate the refractive error change in patients with fully accommodative esotropia.

METHODS:

Patients diagnosed as having fully accommodative esotropia (esotropic deviation that started before 7 years of age and less than 8 to 10 prism diopters [PD] of esotropia with full hyperopic correction and/or bifocals) were included in this retrospective population-based cohort study. Refractive error changes were recorded. For comparisons, patients were divided into two groups: nondecompensated fully accommodative esotropia group and decompensated fully accommodative esotropia group.

RESULTS:

Two hundred and twenty-three patients met the inclusion criteria. The mean follow-up time was 5.94 ± ۰.۳۱ years (range: 5 to 8 years). The changes in spherical equivalent in the younger than 7 years, 7 to 12 years, and 12 to 17 years groups were statistically significant (P < .001). The decrease of hypermetropia was 0.13 diopters/year between 7 and 12 years and 0.06 diopters/year between 12 and 17 years. Forty-one of 223 patients (18.4%) discontinued spectacle therapy during the follow-up period. Hyperopic error and presence of amblyopia were lower, whereas visual acuity level and presence of near-distance disparity were higher in the spectacle discontinuation group (P < .001, .007, .01, and 0.01, respectively). Deterioration of fully accommodative esotropia occurred in 30 of 223 patients (13.5%). Boys were more likely to require strabismus surgery (P = .۳۲). The mean age at presentation, esotropia angle with and without refractive correction at both near and distance fixation, near distance disparity, and inferior oblique overaction were significantly higher in patients with decompensated fully accommodative esotropia.

CONCLUSIONS:

Hyperopic error increased from the initial level until 7 years of age, followed by a myopic shift thereafter. Few children had resolution of fully accommodative esotropia and could discontinue spectacle therapy. Children with male gender, higher esotropia angle, older age at presentation, near-distance disparity, and inferior oblique overaction experienced a greater deterioration of the fully accommodative esotropia.

Effect of Age at Primary Intraocular Lens Implantation on Refractive Growth in Young Children

Adrianna E. Eder, MD; Kyle F. Cox, MD; T. Amerson Pegram, MD; Scott M. Barb, MD; Mary Ellen Hoehn, MD; Natalie C. Kerr, MD

Abstract

PURPOSE:

To evaluate the effect of age at primary intraocular lens (IOL) implantation on rate of refractive growth (RRG3) during childhood.

METHODS:

A retrospective chart review was performed for children undergoing primary IOL implantation during cataract surgery. RRG3 was calculated for one eye from each patient using the first postoperative refraction, last refraction that remained stable (< 1.00 diopters [D] change/2 years), and the corresponding ages. RRG3 values for pseudophakic patients operated on from ages 0 to 5 months were compared with values for patients operated on at ages 6 to 23 months and 24 to 72 months. Patients with refractive errors that stabilized were grouped by age at surgery to compare age at refractive plateau.

RESULTS:

Of 296 eyes identified from 219 patients, 46 eyes met the inclusion criteria. There was a statistically significant difference in RRG3 among age groups. The mean RRG3 value was −۱۹.۸۲ ± ۵.۲۳ D for the 0 to 5 months group, −۲۲.۳۲ ± ۷.۴۵ D for the 6 to 23 months group (0 to 5 months vs 6 to 23 months, P = .۴۳), and −۹.۶۴ ± ۱۱.۹۵ D for the 24 to 72 months group (0 to 5 months vs 24 to 72 months, P = .۰۱).

CONCLUSIONS:

Age at primary IOL implantation affects the RRG3, especially for children 0 to 23 months old at surgery. Surgeons performing primary IOL implantation in infants may want to use age-adjusted assumptions, because faster refractive growth rates can be expected in young children.

Congenital Eyelid Imbrication Syndrome Mimicking Ophthalmia Neonatorum

Sai Vijitha Vempuluru, MS; Devjyoti Tripathy, MS

A 1-day-old female neonate, born of full-term spontaneous vaginal delivery, presented with gross swelling of the left upper eyelid that was noted at birth. The left eye had mucopurulent discharge with a completely everted upper eyelid (Figure ۱A). The right eye showed eyelid laxity with overriding of the upper over the lower eyelid. Easy spontaneous eversion of the eyelids was noted on attempted opening. Both eyelids showed tarsal conjunctival hyperemia (Figure ۱B, hatched arrows). The left upper tarsal plate was completely everted (Figure ۱C, asterisk) with a grossly chemosed, ballooned tarsal conjunctiva (Figure ۱C, star). On suspicion of ophthalmia neonatorum, conjunctival swabs were taken for culture but yielded negative results. The patient was diagnosed as having congenital eyelid imbrication syndrome associated with floppy eyelids. Repositioning of the prolapsed tarsal conjunctiva with patching of the left eye led to resolution. At 8 weeks of age, the imbrication resolved completely (Figure ۱D), although mild residual eyelid laxity was still evident. Congenital eyelid imbrication syndrome is an extremely rare disorder that results from laxity of the eyelids and is characterized by a triad of overriding of upper eyelids, medial and lateral canthal laxity, and tarsal conjunctival hyperemia.۱,۲ Fewer than 10 such cases have been reported in the literature.۲,۳ In this instance, an uncommon clinical presentation of gross conjunctival chemosis with ocular discharge associated with eyelid imbrication syndrome closely mimicked ophthalmia neonatorum.