Prognosis of binocularity in accommodative esotropia.

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  • 調節性内斜視の治療予後

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Purpose: To investigate the binocularity in patients with accommodative esotropia and partial accommodative esotropia.<BR>Subjects and Methods: Subjects were 53 consecutive patients (average age: 4.5 years) who were diagnosed with accommodative esotropia and partial accommodative esotropia at Hyogo College of Medicine Hospital between 2005 and 2008 and were followed up for a period of at least 2 years. Of 53, 32 patients (average age, 4.6 years) had accommodative esotropia and 21 patients (average age, 4.5 years) had partial accommodative esotropia. After wearing glasses corrected by cycloplegics, the subjects were managed with Fresnel membrane prisms, treated surgically or followed up without treatment. We investigated the factors that had influenced their binocularity. <BR>Results: Of the 32 patients with accommodative esotropia, 13 (41%) patients demonstrated normal stereopsis less than 100_ by Titmus stereo test and 13 (41%) patients had no stereopsis. The risk factors for poor binocularity included the initial visual acuity less than 0.3 and the eye position showing esotropia after 1-month treatment with glasses. Four patients (19%) with partial accommodative esotropia demonstrated normal stereopsis. Patients treated with Fresnel membrane prisms and those treated with a combination of Fresnel membrane prisms and strabismus surgery showed better binocularity than the patients without treatment and those treated with strabismus surgery alone. <BR>Conclusion: In order to achieve stereopsis, it is necessary to manage the eye position within esophoria or orthophoria, with or without schedule for strabismus surgery. In addition, it is effective to wear glasses with Fresnel membrane until surgery, especially for patients with partial accommodative esotropia.<BR>Conclusion: The maintenance of eye position is essential for good binocularity. Particularly, using Fresnel membrane prism to maintain the eye position until surgery might be effective in patients with partial accommodative esotropia.

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