Follow-up of nonrefractive accommodative esotropia with myopia 22 years

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  • 近視を伴う非屈折性調節性内斜視22年間の経過

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[Purpose] To report a case of non-refractive accommodative esotropia with myopia, which we have followed up for 22 years.<br>[Case] The patient was a female and was 5 years old at the first medical examination. The initial eye positions were 8⊿X(T) (far) and 25⊿ET'2⊿LHT' (near). Under accommodative palsy by 1% atropine, objective refractive error of＋1.00 D in both eyes and stereopsis at far only were confirmed. When the patient was 8 years old, the subjective refraction was -1.50 D in both eyes and the eye positions were 18⊿X(T) 16⊿LH(T) (far) and 13⊿E(T)' 3⊿LH(T)' (near), 15⊿XP' with addition power of ＋3.00 D for near vision. The near gradient AC/A ratio was 9.3 ⊿/D. Two months later, esotropia manifested and two Fresnel films of 5⊿ base-out each were added to the bottom of the single focus glasses for phoria maintenance. In the same year, the patient received medial rectus muscle resection and lateral rectus muscle recession on the left eye because of exotropia at far position and the exotropia almost disappeared. However, esotropia at near had increased to 25⊿. To correct the eye position at near, bifocal glasses with addition power of ＋3.00 D for near vision were prescribed. After that, the patient's eye position has been controlled using glasses and Fresnel film, and we have continued to follow up the case. The patient is currently 27 years old with myopia of -5.75 D in both eyes. Because the patient preferred single focus glasses, low correction single focus glasses with a power of -5.00 D for both eyes were prescribed. Eye positions for distance and near visions and binocular function were all stable.<br>[Discussion] Non-refractive accommodative esotropia in adults with myopia is difficult to be completely cured because the high AC/A ratio still remains. Bifocal glasses are usually the first-choice treatment. However, in cases with myopia, single focus glasses can also be considered even if acuity for distance vision has to be somewhat compromised. To improve patient's QOL, patient's opinions should also be considered in addition to changes in eye position and refraction to determine the best treatment.

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