USA: Strabismus, in particular, exotropia, is common 10 years following infant monocular cataract surgery, regardless of aphakia management. Delayed exotropia emergence with longer follow-up suggests the need for caution in early esotropia management in these children. These are the findings from a recent study published in the Journal of American Association for Pediatric Ophthalmology and Strabismus.
The study was conducted by Erick D.Bothun, Departments of Ophthalmology, Mayo Clinic, Rochester Minnesota, and colleagues with the objective to characterize long-term strabismus outcomes in children in the Infant Aphakia Treatment Study (IATS).
The researchers performed secondary data analysis of long-term ocular alignment characteristics of children aged 10.5 years who were enrolled previously in a randomized clinical trial evaluating aphakic management after unilateral cataract surgery between 1 and 6 months of age.
The study led to the following findings:
In the IATS study, 88% developed strabismus through the age of 10.5 years.
Half of the 20 children who were orthophoric at distance through age 5 years maintained orthophoria at distance fixation at 10.5 years.
Esotropia was the most common type of strabismus prior to age 5 years (51%), whereas exotropia (45%) was the most common type of strabismus at 10.5 years (esotropia, 21%; isolated hypertropia, 17%).
Strabismus surgery had been performed on 52 children (48%), with 18 of these (35%) achieving microtropia <10Δ.
Strabismus was equally prevalent in children randomized to contact lens care compared with those randomized to primary intraocular lens implantation (83% vs 82%).
Median visual acuity in the study eye was 0.56 logMAR (20/72) for children with orthotropia or microtropia <10Δ versus 1.30 logMAR (20/400) for strabismus ≥10Δ.
The researchers wrote, "The delayed emergence of exotropia with longer follow-up indicates a need for caution in managing early esotropia in these children."
"Children with better visual acuity at 10 years of age are more likely to have better ocular alignment."
Reference:
Bothun ED, Shainberg MJ, Christiansen SP, Vanderveen DK, Neely DE, Kruger SJ, Cotsonis G, Lambert SR; Infant Aphakic Treatment Study. Long-term strabismus outcomes after unilateral infantile cataract surgery in the Infant Aphakia Treatment Study. J AAPOS. 2022 Jul 14:S1091-8531(22)00130-6. doi: 10.1016/j.jaapos.2022.05.003. Epub ahead of print. PMID: 35843488.