Strabismus surgery may improve outcomes in adults with comitant non-accommodative esotropia: Study

A recent retrospective study found the clinical characteristics and surgical outcomes of adults suffering from comitant non-accommodative esotropia. This condition is characterized by inward deviation of the eyes, affects many adults and often leads to significant visual disturbances such as diplopia (double vision).

The study spanned nearly a decade from 2014 to 2023 and meticulously reviewed the medical records of 219 patients aged between 18 and 60 years who underwent strabismus surgery. The patient cohort predominantly consisted of women who accounted for 64% of the cases, with an average age of 36.7 years. 72% of the patients were myopic which indicated a high prevalence of nearsightedness among the patients affected by this condition.

This study categorized esotropia into three distinct groups based on the disparity between near and distance angles of deviation as, basic esotropia (ETBA), esotropia divergence insufficiency pattern (ETDI) and esotropia convergence excess pattern (ETCE). This classification helped to better understand the varying presentations of the condition and tailor surgical interventions accordingly.

The key findings from the study revealed that patients in the ETCE group expressed the largest mean deviations with 45.5 prism diopters (PD) at distance and 64 PD at near. Also, the ETBA group demonstrated the greatest range in deviations with 31 PD at distance and 30 PD at near which highlighted the variability in esotropic presentations.

Two primary surgical techniques [bilateral medial rectus recession (BMR) and unilateral recess-resect (R&R)] were employed with equal frequency. The outcomes of these procedures highlighted motor success that was defined as a post-surgical deviation of 10 PD or less and was significantly higher in patients who underwent the R&R procedure (87.8%) when compared to the patients who had the BMR surgery (73.2%). The sensory success which indicates improved binocular vision was also more common with R&R (93.3%) than BMR (85.5%), though this difference did not reach statistical significance. By the final follow-up, an impressive 88.1% of patients who initially underwent diplopia achieved single binocular vision which illuminates the efficacy of the surgical interventions.

Overall, the study highlights that regardless of the esotropia pattern, adults with comitant non-accommodative esotropia can expect favorable motor and sensory outcomes following strabismus surgery. These findings provide valuable insights for ophthalmologists and can significantly influence the approach to surgical management in such patients by improving their quality of life.

Source:

Cavuoto, K. M., Tibi, C., Rosa, P. R., & Capo, H. (2024). Characteristics and Surgical Outcomes of Comitant Esotropia in an Adult Population Between 18 and 60 Years Old. In American Journal of Ophthalmology. Elsevier BV. https://doi.org/10.1016/j.ajo.2024.06.012