Elsevier

Ophthalmology

Volume 110, Issue 6, June 2003, Pages 1230-1236
Ophthalmology

Management of strabismus in nanophthalmic patients: A long-term follow-up report

Presented in part at the 35th National Congress of the Turkish Ophthalmological Society, Izmir, Turkey, September 2001.
https://doi.org/10.1016/S0161-6420(03)00267-7Get rights and content

Abstract

Purpose

The purpose of this study is to identify the characteristics of strabismus that coexist with nanophthalmos and to report the results of strabismus surgery performed on these small eyes.

Design

Retrospective, consecutive, noncomparative interventional case series.

Participants

Fifteen bilateral nanophthalmic patients, of whom five underwent horizontal muscle surgery, were included in this study.

Methods

Chart review. The clinical examination included visual acuity assessments using the linear Snellen and the Lea charts, slit-lamp and fundus examinations, intraocular pressure, and axial length measurements. The orthoptic examination consisted of measurements of ocular deviations using the prism cover test with an accommodative target at both near and distance with and without refractive correction, assessment of ocular motility with ductions and versions, binocularity with Worth’s four-dot test, and the Titmus test. Amblyopia was treated with part-time occlusion. Surgery for the correction of esotropia included bilateral medial rectus recessions or recess–resect procedures.

Main outcome measures

Magnitude of strabismic deviation, best-corrected visual acuity, and the level of binocular vision achieved were monitored.

Results

The average age of enrollment in the study was 4.7 (range, 1–12) years. The patients were followed for an average of 7.0 (range, 4–14) years. The mean axial length was determined as 18.4 mm (range, 15.5–20.7). The mean refractive error in spherical equivalents was measured as +9.9 and ranged between +4.0 and +15.0 diopters. Five patients (33%) had nonaccommodative esotropia, four (27%) had partially refractive esotropia, four (27%) had microesotropia, and two (13%) had exotropia. Five patients, all having nonaccommodative esotropia, underwent surgery for the correction of ocular misalignment. Diminishing the surgical dose in these small eyes resulted in undercorrections. Despite patching, 3 patients (20%) had unilateral and 12 patients (80%) had bilateral amblyopia at the conclusion of the study.

Conclusions

Strabismus in nanophthalmos usually manifests as nonaccommodative and partially refractive esotropia. Medial rectus recession should be applied with care to prevent adduction deficit and convergence insufficiency. Otherwise, there seems to be no need for decreasing the surgical dose with regard to the smaller axial length. Amblyopia tends to be persistent in these patients.

Section snippets

Material and methods

The records of 15 consecutive patients who had bilateral nanophthalmos and strabismus were retrospectively reviewed in this study. Twenty-three eyes of 12 patients had axial length measurements less than 20 mm. Seven eyes of four patients had axial length values between 20 and 21 mm; all these patients showed clinical characteristics of nanophthalmos, including slightly shallow anterior chambers and high hypermetropia of at least 5 D. None of the patients had associated dysmorphic features or

Results

Of the 15 patients with nanophthalmos and strabismus, 7 were male and 8 were female. The average age at which the patients were enrolled in the study was 4.7 (range, 1–12) years. The average age of these patients on the completion of the study was 11.5 (range, 8–17) years. The patients were followed for an average of 7.0 (range, 4–14) years. The systemic physical examinations did not yield any additional problems. The mean axial length was determined as 18.4 mm (range, 15.5–20.7). The axial

Discussion

Despite the known association between hyperopia and strabismus, to the best of our knowledge no study has specifically evaluated nanophthalmic patients with concurrent strabismus. This study both identifies the types of strabismus that are associated with nanophthalmos and also investigates the results of surgical procedures performed for ocular misalignment.

Nanophthalmos has been classified as simple microphthalmos, which differs from other types of microphthalmos by the absence of associated

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Cited by (0)

Manuscript no. 220169.

The authors have no financial interest in this study.

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