Berk A Tülin, Koçak Nilüfer, Ellidokuz Hülya
Department of Ophthalmology, Dokuz Eylul University, Yzmir, Turkey.
J AAPOS. 2004 Aug;8(4):384-8. doi: 10.1016/j.jaapos.2004.02.001.
To document and compare the clinical features and functional outcomes in patients with accommodative esotropia. To assess the efficacy of conventional management of accommodative esotropia, to determine functional outcomes of amblyopia and binocular vision, and to analyze possible risk factors involving the development of amblyopia.
We retrospectively reviewed the charts of 147 patients whose esotropia was corrected to within 10 prism diopters of orthotropia at both distance and near with use of full cycloplegic hyperopic correction. Multiple parameters were reviewed, including initial and final cycloplegic refraction, distance, and near deviation with and without glasses, stereoacuity, age of onset, and initiation of treatment, presence of anisometropia, and change in hyperopia.
At presentation, 87 (59.2%) of the 147 patients were amblyopic, and anisometropia was found to be the only statistically significant risk factor for this (P = .001). Only 24.2% of these patients have stereo acuity between 40 and 100 sec/arc, 20.96% of patients have 200 to 800 sec/arc, and 22.58% of patients have 1980 to 3000 sec/arc; the remaining 32.26% had no stereo acuity. Fusion was achieved in 73.5% of the patients and later presentation (> 24 months) of esodeviation significantly determined their fusional ability (P = .031). Consecutive exotropia developed in 5.4 % of the patients an average of 5.5 years after institution of full optical correction. For clinical and functional outcomes we did not find any statistically significant difference between early onset (before 1 year old) and typical onset (2 to 3 years) age groups. The trend towards decreasing hyperopia was apparent, averaging -0.16 +/- 0.20 diopters annually in 80.5% of the patients with at least 5 years follow-up, although 23% of patients still had 20/40 or worse visual acuity in the amblyopic eye.
Amblyopia is a commonly associated finding at presentation for patients with accommodative esotropia. Most of the patients developed good fusion but poor stereopsis at the end of treatment.
记录并比较调节性内斜视患者的临床特征和功能预后。评估调节性内斜视传统治疗方法的疗效，确定弱视和双眼视觉的功能预后，并分析弱视发生的可能危险因素。
我们回顾性分析了147例患者的病历，这些患者通过使用完全睫状肌麻痹远视矫正，其远近距离内斜视均矫正至正交位10棱镜度以内。回顾了多个参数，包括初始和最终睫状肌麻痹验光、有无眼镜时的远近距离斜视度、立体视锐度、发病年龄、治疗开始时间、屈光参差的存在情况以及远视度数的变化。
就诊时，147例患者中有87例（59.2%）患有弱视，屈光参差被发现是唯一具有统计学意义的危险因素（P = 0.001）。这些患者中只有24.2%的立体视锐度在40至100秒/弧之间，20.96%的患者在200至800秒/弧之间，22.58%的患者在1980至3000秒/弧之间；其余32.26%没有立体视锐度。73.5%的患者实现了融合，内斜视较晚出现（>24个月）显著决定了他们的融合能力（P = 0.031）。5.4%的患者在完全光学矫正后平均5.5年出现连续性外斜视。对于临床和功能预后，我们在早发性（1岁前）和典型发病年龄组（2至3岁）之间未发现任何统计学上的显著差异。远视度数下降的趋势明显，在至少随访5年的80.5%的患者中，平均每年下降-0.16±0.20屈光度，尽管23%的患者弱视眼视力仍为20/40或更差。
弱视是调节性内斜视患者就诊时常见的相关表现。大多数患者在治疗结束时实现了良好的融合，但立体视较差。
