Clinical Features of Acquired Esotropia and Surgical Management in a Real-World Cohort of Myopic Patients.

BACKGROUND: The global increase in myopia prevalence has led to greater interest in associated esotropias. While myopic patients can present with common or special forms of strabismus (e.g., "heavy eye syndrome"), the relative incidence of associated strabismus and best surgical approaches are not widely understood. The purpose of this study was to present a "real-world" cohort of myopic patients with esotropia to determine what diagnostic features are important and how best to treat esotropia in myopia. METHODS: A retrospective case-note review of adults seen at Moorfields Eye Hospital identified 68 cases as follows: age ≥ 18 years, spherical equivalent ≥3.00D, and diagnosis of esotropia. Demographics, orthoptics, refraction, MRI axial length and angle between the lateral and superior rectus muscles (LR:SR angle), surgical technique, and 3-month postoperative outcomes were recorded. RESULTS: At presentation, mean age = 42.4 ± 2.2 years, median refraction = -8.25D, median deviation = 20 prism dioptres (PD) (near and distance) horizontal and vertical 4PD near and 3.5PD distance. There was no correlation between horizontal deviation and spherical equivalent (r = -0.044, P = 0.76). Median axial length was 27.30 mm and LR:SR angle 107.5° by MRI. Thirty-seven patients underwent surgery, 29 unilateral horizontal recess-resect (n = 9/29 fixed sutures, n = 20/29 adjustable), and n = 1 Yokoyama. Median postoperative horizontal deviation was 6PD near (all esodeviation) and 3PD distance (20% exodeviation, 80% esodeviation, 2 patients had a postoperative vertical deviation, and n = 9 required a second procedure). CONCLUSIONS: In this large, real-world, clinically and radiographically characterized cohort of myopic patients, the incidence of special strabismus was low and there was no association between refraction and size of deviation. Unilateral recess-resect procedures provided good outcomes with both adjustable and fixed sutures. This cohort will aid in the everyday management of this increasing clinical problem and form the basis of the further randomized, prospective trials that are greatly needed in this area.