Acquired Nonaccommodative Esotropia in Older Children

Abstract

Purpose: To evaluate the clinical findings and surgical outcomes in older children with acquired nonaccommodative esotropia (ANAET).Methods: A retrospective review was conducted on the medical records of 9 patients (aged 9-17 years) who were diagnosed with ANAET between 2014 and 2021. The age of onset, angle of deviation, presence of symptomatic diplopia, fusional state, stereo-acuity, and surgical results were analyzed.Results: The mean age at onset was 12.0 ± 2.8 years, and the mean duration of esodeviation was 11.8 ± 14.4 months. The mean follow-up period was 32.0 ± 19.5 months. Five of 9 patients presented with symptomatic diplopia accompanying esotropia, and two complained diplopia only. The mean angles of deviation were 32.0 ± 11.5 prism diopters (PD) for near and 31.8 ± 12.4 PD for distance. Six patients showed progressive esotropia, and none had neurological or intracranial disorders. Surgical correction was performed at 17.1 ± 15.0 months after the onset. At the final follow-up, all patients resolved diplopia, and 88.9% achieved successful motor alignment. Improved stereopsis was observed in all patients, with 77.8% demonstrating fusion at both near and far distant. However, only 44.4% gained normal 60 arcsec stereopsis.Conclusions: Diplopia with estropia was the main presenting symptom of ANAET in older children. Surgical treatment was effective in achieving good postoperative motor alignment and fusion, but recovery of fine steropsis was limited.