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Sara Grace, Kara Marie Cavuoto, Hilda Capo, Wei Shi; Role of Strabismus Surgery in the Treatment of Adult-Onset Esotropia. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5219.
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Our study aims to describe a large cohort of patients with adult-onset esotropia of diverse etiologies in terms of their pre-surgical characteristics, operative data and surgical outcomes.
A retrospective chart review was conducted for 249 patients that underwent strabismus surgery for adult-onset esotropia within the past 15 years at a large academic center. Primary outcome measures were resolution of diplopia and a deviation less than 10 PD at distance and near in primary position.
Mean age at esotropia diagnosis was 52 years (18-87). The most common diagnosis overall was cranial nerve six palsy (36%), followed by thyroid eye disease (18%) and divergence insufficiency (15%). Pre-operative diplopia was experienced in 94% of patients. Approximately half (46%) of patients utilized prism preoperatively, and 13% had undergone prior strabismus surgery for adult-onset esotropia. Adjustable sutures were employed in 79%, with one-third adjusted on the day of surgery. At 2 months post-operatively, 79.4% and 82.9% of patients measured ≤ 10 PD at distance and near, respectively. At 2 months post-operatively, significant differences in resolution of diplopia were found across all diagnoses for the unilateral recess/resect procedure and the vertical muscle transposition procedure. At last visit, there was not a significant difference in diplopia resolution for all diagnoses between all surgeries. Non-significant differences were seen in dose-effects per 1 mm of surgery across the three main diagnoses.
Multiple surgical approaches yielded successful results. To determine if significant differences exist for specific surgeries amongst individual diagnoses, larger subgroups are needed, however the simple averages for dose effect may suggest this possibility. DI patients may not follow standard surgical algorithms.
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