The features of diagnosis and treatment of unilateral concomitant strabismus with visual fixation defect in preschool children

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Abstract

BACKGROUND: Particular difficulties in treatment of children with monolateral strabismus are associated with the presence of severe amblyopia in the squinting eye in combination with a visual fixation defect (acentral or intermittent).

AIM: To assess the anatomical and functional status of children with visual fixation defects, to find out the causes of failures in treatment of this group of patients, to determine the tactics of their management.

MATERIALS AND METHODS: The study included 92 children of preschool age (from 3 to 7 years) with monolateral concomitant strabismus. The follow-up period for the children ranged from 12 to 72 months. The average age of the examined children was 4.6 ± 1.1 years. Three variants of visual fixation were identified in the squinting eye: central visual fixation (CVF) – 68 eyes; intermittent visual fixation (IVF ) – 7 eyes; and acentral visual fixation (AVF) – 17 eyes. All patients underwent a comprehensive examination: visometry; strabometry; autorefractometry; determination of the critical frequency of light flashes; assessment of visual fixation; optical coherence tomography of the retina. All children underwent “passive” and active pleoptics.

RESULTS: The visual acuity of children with CVF significantly increased due to pleoptics. At the same time in cases of IVF and even more in those of AVF, visual acuity remained significantly lower than that of the “fixating” eye, pleoptics were ineffective in this group of patients. In patients with CVF, the critical frequency of light flashes of the squinting eye increased in statistically significant figures, while in IVF and AVF, the difference between squinting and fixing eye remained. According to OCT data, changes in the macular area were detected in 18 (75%) eyes in patients with IVF and AVF, which allows us to distinguish organic pathology from amblyopia.

CONCLUSIONS: In children with monolateral strabismus, it is necessary to determine visual fixation of the squinting eye. At IVF and AVF, it is mandatory to conduct optical coherence tomography of the macular area to exclude organic pathology. In patients with monolateral concomitant strabismus with IVF and AVF, surgery on oculomotor muscles is indicated.

About the authors

Nadezhda E. Kononova

St. Petersburg State Pediatric Medical University

Author for correspondence.
Email: Nali-6@yandex.ru
ORCID iD: 0000-0002-2145-1762
SPIN-code: 7217-3582

ophthalmologist

Russian Federation, 2 Litovskaya str., Saint Petersburg, 194100

Evgenij E. Somov

St. Petersburg State Pediatric Medical University; S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”

Email: nali-6@yandex.ru
ORCID iD: 0000-0001-8999-6614
SPIN-code: 6403-6911

Dr. Sci. (Med.)

Russian Federation, 2 Litovskaya str., Saint Petersburg, 194100; Saint Petersburg

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2. Fig. 1. Types of AVF squint eye with monolateral strabismus. a – macula, b – fovea, c – foveola

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3. Fig. 2. Graph of the thickness of the central retina in paired eyes in children with AVF with monolateral strabismus: a – nasal sector of the external subfield, b – nasal sector of the internal subfield, c – minimum central thickness, d – temporal sector of the internal subfield, e – temporal sector of the external subfield

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4. Fig. 3. Examples of retinal OCT with monolateral strabismus: a – child A., 6 years old. The macular profile of the retina was deformed due to a defect in the nerve fiber layer. Left eye without pathology; b – child B., 6 years old. The smoothness of the foveolar depression, the expansion of the foveola, and the violation of the differentiation of layers were recorded. Right eye without pathology; c – child M., 3 years old. Gentle slopes of the fovea and flattening of the pit were recorded. Right eye without pathology

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Copyright (c) 2021 Kononova N.E., Somov E.E.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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