The management of childhood esotropia with hyperopia.

Purpose: Esotropia, especially accommodative estropia (AE), is often seen in patients with hyperopia. In this paper, the authors aim to report the management methods of different types of esotropia in children with hypermetropia and to show the feasibility and efficacy of prismatic correction in the management of small angle of residual esotropia in accommodative estropia.

Methods: A total of 82 esotropes with hyperopia treated during a 2-year period from 2007 to 2009 were reviewed retrospectively. Data were collected from the medical records.

Results: A total of 25 patients showed pure accommodative esotropes, whereas 45 had partial AE and 12 non-AE. All 25 pure AE patients were corrected fully using glasses alone, and all 12 non-AE patients received surgery. Among the 45 partial AE cases, 35 patients with residual esodeviation of ≤30 PD received prismatic correction, with a success rate of 71.4% (25 of the 35 patients). The remaining 10 children who were not successfully treated with prismatic correction and the other 10 partial AE with residual esodeviation of >30 PD received surgery. The most recent follow-up examination indicated that all the non-surgical children were orthotropia or esophoria or had residual esotropia ≤10 PD. Among the surgical patients, 5 patients (5 in 32 or 15.6%) exhibited unstable alignment during the postoperative follow-up period, and 10 patients (10 in 32 or 31.25%) underwent additional surgery for residual esotropia.

Conclusions: Treatment of estropia in children with hyperopia includes wearing glasses, glasses combined with prism glasses and surgery. Prismatic correction in the treatment of small angle of residual esotropia in partial AE was feasible and efficacious. Since the follow-up lasted only a year, a long-term follow-up is needed in future studies to investigate the efficiency of the treatments.