Long-term development of refractive error in refractive, nonrefractive and partially accommodative esotropia

Accommodative esotropia (AE) is a convergent deviation due to an excess of the convergence linked to the innervational stimulus for accommodation and it is usually associated to the presence of hyperopia. The development of hyperopia over time has been widely described but the lack of comparative analysis among accommodative esotropia subtypes, does not allow to verify the existence of different developmental patterns. In this study we aimed to describe the long term changes of refractive error in patients affected by accommodative esotropia as a function of the strabismus type: refractive (RAE), non-refractive (NRAE) and partially accommodative esotropia (PAE). The medical records of 66 patients (24 RAE, 22 PAE, 20 NRAE), who wore the full correction of their cycloplegic refraction error during the entire follow up period, were retrospectively reviewed. Mean outcome was the analysis of the variations, among groups, of refractive error over time; differences between mild (≤3.00D) and high (≥5.00D) hyperopia, effects of amblyopia and relationship with AC/A ratio were also investigated. All patients were followed up from approximately 4 years of age to 20, with mean follow up of 16.06±0.29 years. Our results described similar non-linear trend of refractive error development among groups. The initial increase of hyperopia (up to 7–8 years) was followed by a decreasing trend persisting up to adulthood (approximately 20 years of age). During this period, spherical equivalent decreased at a lower mean annual rate in patients affected by RAE (-0.07D) compared to other groups (NRAE -0.11D, p = 0.003 and PAE 0.13D, p = 0.002). In all groups, however, significant amount of hyperopia was found at last examination; indeed the observed difference in SE values from baseline to the end of follow up, was not significant (RAE: +0.27D, 95% C.I. -0.49 to +1.04D, p = 0.472; PAE: -0.69D, 95% C.I. -1.67 to +0.28D, p = 0.154; NRAE: -0.39D, 95% C.I. -1.11 to +0.34D, p = 0.278). AC/A ratio, amblyopia and amount of initial hyperopia appeared to have no significant role in longitudinal change of the refractive error. In conclusion, this study provides a complete overview, from childhood to adulthood, of refractive error development in different form of accommodative esotropia.调节性内斜视（Accommodative Esotropia, AE）是因调节相关的神经支配刺激过强而引发的集合性斜视，通常伴随远视状态出现。目前，远视随时间进展的特征已被广泛报道，但由于缺乏针对调节性内斜视各亚型的对比分析，学界尚未能验证不同亚型是否存在差异化的发育模式。本研究旨在依据斜视亚型——屈光性调节性内斜视（Refractive Accommodative Esotropia, RAE）、非屈光性调节性内斜视（Non-Refractive Accommodative Esotropia, NRAE）以及部分调节性内斜视（Partially Accommodative Esotropia, PAE）——分析调节性内斜视患者屈光状态的长期变化。本研究回顾性分析了66例患者的临床病历资料（其中RAE组24例、PAE组22例、NRAE组20例），所有受试者在整个随访周期内均全程佩戴睫状肌麻痹验光（cycloplegic refraction）所得的全矫眼镜。本研究的核心分析内容包括：各组屈光状态随时间的变化差异、轻度（≤3.00D）与重度（≥5.00D）远视患者间的差异、弱视（amblyopia）的影响，以及与调节集合比（AC/A Ratio）的相关性。所有受试者的随访均从约4岁起始至20岁，平均随访时长为16.06±0.29年。本研究结果显示，各组患者的屈光状态发育均呈现相似的非线性趋势：远视度数先随年龄增长逐渐升高，于7~8岁达到峰值，随后持续下降直至成年（约20岁）。在此期间，RAE组患者的球镜当量（Spherical Equivalent, SE）年均变化速率为-0.07D，显著低于其他组别（NRAE组为-0.11D，p=0.003；PAE组为0.13D，p=0.002）。但在所有组别中，末次随访时仍存在显著程度的远视。具体而言，各组球镜当量从基线至随访终点的变化量均无统计学意义（RAE组：+0.27D，95%置信区间-0.49~+1.04D，p=0.472；PAE组：-0.69D，95%置信区间-1.67~+0.28D，p=0.154；NRAE组：-0.39D，95%置信区间-1.11~+0.34D，p=0.278）。调节集合比、弱视以及初始远视度数，似乎均对屈光状态的纵向变化无显著影响。综上，本研究完整阐述了从儿童期至成年期，不同亚型调节性内斜视患者的屈光状态发育特征。