Distance–near disparity esotropia: can we shrink the gap?

Abstract

Distance-near disparity esotropias are a group of heterogenous usually acquired strabismus disorders, where the angle of misalignment at near exceeds that at distance by 10 prism diopters or more, where the accurate correction of refractive errors and ambylopia are important early objectives. These aetiologically diverse entities respond non-uniformally to strabismus surgery and bifocals. The management challenge is one of 'shrinking' the disparity so that the affected individuals can develop and comfortably maintain binocular single vision and/or optimal alignment. Surgical procedures have continued to evolve but none of the current operative procedures are superior for all patients. Subclassifying this strabismus and highlighting publication data from more homogenous clinical series may assist with the optimisation of future management and treatment outcomes.

Combined resection–recession versus combined recession–retroequatorial myopexy of medial rectus muscles for treatment of near-distance disparity Esotropia

“… 18 Some authors worked on far angle of deviation, while some worked on mean angle of near and far deviations. 19 Yet, others worked on the near angle of deviation but their results showed high incidence of distance exophoria. 20…”

Development and Validation of a Nomogram for Predicting Second Surgery in Patients with Concomitant Esotropia

“…The results suggest that amblyopia and DVD before CE surgery are risk factors for developing CX postoperatively. Burke [ 9 ] studied acquired CE with deviation angles of the distance-near disparity greater than 10 PD and believed that timely and adequate refractive correction and amblyopia treatment were the key factors for the success of the surgery. Lembo and colleagues [ 10 ] pointed out that accommodative CE is the most common form of CE in children, and some patients with accommodative CE often have amblyopia at the same time.…”

“…However, the results of these factors are quite different in different studies. Burke [ 9 ] also pointed out that since many articles on the effect of CE surgery are retrospective, there are large differences in the sample size, follow-up time, case classification, and observation indicators, which affect the reliability of the results. For example, many articles do not classify esotropia subtypes and do not consider whether different subtypes have significantly different treatment outcomes.…”

Surgical Management of Convergence Excess Esotropia

“…Different surgical approaches have been described to reduce distance-near disparity with variable degrees of effectiveness and complications. These approaches include slanted medial rectus recession, posterior fixation sutures, medial rectus muscle pulley posterior fixation, marginal myotomy, and combined resection-recession of medial rectus muscles [6][7][8][9][10][11][12][13][14][15] .…”