Long-term strabismus outcomes after unilateral infantile cataract surgery in the Infant Aphakia Treatment Study

• Type of Material: Article
• Authors: Erick D Bothun, University of Minnesota Twin Cities; Marla J Shainberg, University of Tennessee Health Science Center; Stephen P Christiansen, Boston University School of Medicine; Deborah K Vanderveen, Harvard Medical School; Dan E Neely, Indiana University-Purdue University Indianapolis; Stacey J Kruger, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; George Cotsonis, Emory University; Scott Lambert, Emory University
• Language: English
• Date: 2022-08-01
• Publisher: Elsevier Inc
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jaapos.2022.05.003
• Title of Journal or Parent Work: Journal of AAPOS
• Volume: 26
• Issue: 4
• Start Page: 174.e1
• End Page: 174.e4
• Keywords: Follow-Up Studies; Infant; Cataract Extraction; Aphakia, Postcataract; Exotropia; Child; Pseudophakia; Humans; Esotropia; Lens Implantation, Intraocular; Cataract; Strabismus

Abstract

Purpose: To characterize long-term strabismus outcomes in children in the Infant Aphakia Treatment Study (IATS). Methods: This study was a secondary data analysis of long-term ocular alignment characteristics of children aged 10.5 years who had previously been enrolled in a randomized clinical trial evaluating aphakic management after unilateral cataract surgery between 1 and 6 months of age. Results: In the IATS study, 96 of 109 children (88%) developed strabismus through age 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 (56/109 [51%]), whereas exotropia (49/109 [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 (45/54 [83%] vs 45/55 [82%]; P = 0.8). 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 (P = 0.0003). Conclusions: Strabismus—in particular, exotropia—is common irrespective of aphakia management 10 years following infant monocular cataract surgery. 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.[Formula presented]