Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, MN, USA.
Division of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN, USA.
Eur J Ophthalmol. 2021 Nov;31(6):3342-3348. doi: 10.1177/1120672120977831. Epub 2020 Dec 24.
The purpose of this retrospective cohort study was to report the outcomes of high AC/A ratio accommodative esotropia (AET) among children.
The medical records of all children <19 years diagnosed with accommodative esotropia and a high AC/A ratio while residing in Olmsted County, Minnesota, from January 1, 1975, through December 31, 2004, were retrospectively reviewed.
A total of 512 patients were diagnosed with AET during the 30-year study period, of which 395 (77.1%) had fully accommodative ET, 117 (22.8%) had partially accommodative ET and 106 (20.5%) had a high AC/A ratio. Of the 93 (87.7 %) high AC/A patients managed with bifocals, 50 (53.8 %) discontinued their use after a mean of 58.7 (range: 5.6-229) months. The Kaplan-Meier rate of discontinuing bifocals was 24.5% at 3 years, 36.4% at 5 years, and 61.4% at 10 years. Patients who discontinued bifocals were more likely to have had strabismus surgery (44% vs 18.6%, = 0.009) than those who did not discontinue bifocals. The high AC/A patients managed with bifocals achieved similar stereoacuity outcomes to those who did not wear bifocals ( = 0.65) and were no more likely to require surgery ( = 0.13).
Among this cohort of children with accommodative esotropia and a high AC/A ratio, bifocal use was discontinued in the majority of children within 10 years, and more commonly among those who underwent strabismus surgery. The use of bifocals was not associated with a higher likelihood of undergoing surgery or enhanced stereopsis compared to those who did not use them.
本回顾性队列研究旨在报告高 AC/A 比调节性内斜视（AET）患儿的治疗结果。
回顾性分析 1975 年 1 月 1 日至 2004 年 12 月 31 日期间，居住在明尼苏达州奥姆斯特德县的所有被诊断为调节性内斜视且 AC/A 比值较高的儿童的病历资料。
在 30 年的研究期间，共有 512 例患者被诊断为 AET，其中 395 例（77.1%）为完全调节性内斜视，117 例（22.8%）为部分调节性内斜视，106 例（20.5%）为高 AC/A 比。在接受双焦镜治疗的 106 例高 AC/A 患者中，93 例（87.7%）接受了双焦镜治疗，其中 50 例（53.8%）在平均 58.7 个月（范围：5.6-229）后停止使用。双焦镜的 Kaplan-Meier 停用率为 3 年时为 24.5%，5 年时为 36.4%，10 年时为 61.4%。停止使用双焦镜的患者更有可能接受斜视手术（44%比 18.6%， = 0.009），而非继续使用双焦镜的患者。接受双焦镜治疗的高 AC/A 患者与未佩戴双焦镜的患者获得相似的立体视锐度（ = 0.65），且更不可能需要手术（ = 0.13）。
在本队列中，患有调节性内斜视和高 AC/A 比的儿童中，大多数儿童在 10 年内停止使用双焦镜，且更常见于接受斜视手术的儿童。与未使用双焦镜的患者相比，使用双焦镜并不增加手术或增强立体视的可能性。
