J Pediatr Ophthalmol Strabismus. 2020 Jul 1;57(4):217-223. doi: 10.3928/01913913-20200504-02.
To determine the factors affecting the risk of deterioration and evaluate the refractive error change in patients with fully accommodative esotropia.
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 decompen-sated fully accommodative esotropia group.
Two hundred and twenty-three patients met the inclusion criteria. The mean follow-up time was 5.94 ± 0.31 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 = .32). 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.
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. [J Pediatr Ophthalmol Strabismus. 2020;57(4):217-223.].
确定影响完全调节性内斜视恶化风险的因素，并评估此类患者的屈光不正变化。
本回顾性基于人群的队列研究纳入了被诊断为完全调节性内斜视（7 岁以前发病且远视矫正后或戴双光镜后斜视度<8 至 10 棱镜度）的患者。记录屈光不正的变化。为进行比较，将患者分为两组：非代偿性完全调节性内斜视组和代偿性完全调节性内斜视组。
223 例患者符合纳入标准。平均随访时间为 5.94±0.31 年（5 至 8 年）。7 岁以下、7 至 12 岁和 12 至 17 岁组的球镜等效物变化有统计学意义（P<.001）。7 至 12 岁时远视减少 0.13 屈光度/年，12 至 17 岁时减少 0.06 屈光度/年。223 例患者中有 41 例（18.4%）在随访期间停止了眼镜治疗。停戴眼镜组远视误差较低，弱视程度较低，而视力水平和近距离视差较高（均 P<.001、.007、.01 和.01）。223 例患者中有 30 例（13.5%）出现完全调节性内斜视恶化。男孩更有可能需要斜视手术（P=.32）。在 presentation 时，有和无矫正时近距和远距的斜视角度、近距离视差和下斜肌过强在代偿性完全调节性内斜视患者中明显更高。
远视误差从初始水平增加至 7 岁，此后出现近视漂移。很少有儿童完全调节性内斜视能够自行缓解，并且能够停止眼镜治疗。男孩、斜视角度较高、presentation 时年龄较大、近距离视差较大和下斜肌过强的儿童更易发生完全调节性内斜视恶化。
