Clinical Characteristics of Patients with Non-Surgical Consecutive Exotropia following Childhood Esotropia: Analysis from a Multicentered Study

Ophtalmologie pédiatrique
Paper Presentation | Présentation d'article
11:15 AM, samedi 11 juin 2022 (12 heures 10 minutes)
Dîner dans la salle d’exposition   12:15 PM à 01:30 PM (1 heure 15 minutes)
Pause dans la salle d’exposition   03:00 PM à 03:45 PM (45 minutes)

Authors: Sina Khalili1, Linda Colpa1, Stephen Kraft1, Coralie Hemptinne2, Darron Bacal3, Demet Yuksel2, Al Cossari4, Kamiar Mireskandari1
1The Hospital for Sick Children, 2UCLouvain (University of Louvain), 3Eye Physicians & Surgeons PC, 4Village Eye Care.

Author Disclosure Block: S. Khalili: None. L. Colpa: None. S. Kraft: None. C. Hemptinne: None. D. Bacal: None. D. Yuksel: None. A. Cossari: None. K. Mireskandari: None.


Title: Clinical Characteristics of Patients with Non-Surgical Consecutive Exotropia following Childhood Esotropia: Analysis from a Multicentered Study


Abstract Body:

Purpose: Spontaneous non-surgical consecutive exotropia (NCX) following childhood esotropia (ET), while uncommon, is a clinical challenge. Studies suggest it occurs in accommodative esotropia with onset less than 2yrs of age in the presence of high hyperopia. These case series have small numbers and varying clinical presentations, making it difficult to establish a definitive patient profile. We assessed clinical characteristics of patients with NCX from a large multicentered cohort to better identify key features and provided insight into the natural course of the condition, as well as its response to clinical management.
Study Design: Retrospective Multicentered Observational study
Methods: Five centers contributed cases from 1980 to 2020. Inclusion criteria was esotropia diagnosis after 6-months of age, confirmed by an ophthalmologist, that spontaneously went exotropic without surgery. Sensory deviations were excluded. Clinical findings, including cycloplegic refraction, glasses prescriptions, vision, deviation and binocularity were collected. Outcomes were assessed for patients who underwent refractive management of their exodeviations versus continued observation.
Results: Forty-nine children were identified at a mean age of 3.5±1.6 and 8.4±3.6 years at the time of ET and NCX, respectively. Mean follow-up after the development of XT was 6.4±4.5 years. Accommodative esotropia was the initial diagnosis in 60% of patients. Amblyopia occurred in 55% of cases while ET, with residual amblyopia in 24.5% at the time of XT. Fusion was documented in 70.4% and 56.2% at the time of ET and XT respectively. Binocularity was not protective against the exotropic drift. Mean cycloplegic refractive error was +4.40±2.13 and +4.05±2.74D at the time of ET and NCX respectively. The percentage of high versus moderate hyperopia was 34.7% and 44.9% respectively. Mean anisometropia was 1.05±0.59D and 1.08±0.66D at the time of ET and NCX respectively. Mean near ET in glasses was 12.7±11.9PD and 7.7±9.4PD at distance. At the time of XT, all but one presented with their exotropia at distance fixation. Mean near XT deviation was 1.1±7.2PD and 8.1±5.9PD at distance. New glasses with decreased hyperopia of 0.85±1.03D were given to 72% in response to their XT. Eventually, 43% had surgery on their exotropias.
Conclusions: NCX occurs in both accommodative and non-accommodative esotropia. ET onset age was older than has been previously reported, which may be a reflection of this mixture of esotropia types Amblyopia and anisometropia were not predictive risk factors. While common, high hyperopia was no more a risk factor than moderate hyperopia. Refractive manipulation for the XT gave modest results, however the incidence of surgery was similar to the continued observation group.