Abstract：
Studies from the UK have reported declining rates of surgery for childhood esotropia. It is not known if this equates to a reduced incidence of essential infantile esotropia (EIE). A national study was undertaken through the British ophthalmology surveillance unit (BOSU) to determine the incidence presenting features and management of EIE in the UKData from a prospective national observational cohort of newly diagnosed EIE presenting to clinicians in the United Kingdom over a 12-month period was collected. Cases with a confirmed diagnosis by a clinician of a constant, non-accommodative esotropia ≥ 20 prism dioptres (PD), presenting at ≤ 12months, with no neurological or ocular abnormalities were identified through BOSU. Follow up data was collected at 12 months. Data was collected on the age, gender, ethnicity, birth history, age at diagnosis, age at intervention, angle of esotropia, refraction, associated features of amblyopia, overelevation in adduction (OEIA), latent nystagmus and dissociated vertical deviation (DVD), method of management and outcomes.During the period of observation between October 2017 to October 2018 a total of 57 cases were reported giving an incidence of EIE of 1 in 12,828 live births with a corrected incidence of 1 in 9027 live births allowing for estimated under reporting. The mean age of diagnosis and intervention were 7.05± 2.6 months (range 2 to 12 months) and 14.7± 4.9 (range 6.5-28.1 months) respectively. The majority were Caucasians 86.5% and 52.7% were female. Management was surgical in 59.6%, and botulinum toxin alone in 22.8%, 17.5% were observed. There was no significant difference in the age of presentation (P=0.6), gender (P=0.8), prematurity (P=0.5), deprivation indices (P=0.68), refraction (P=0.7), OEIA (P=0.6), DVD (P=0.7) or follow up (P=0.3) between the three groups. The preoperative angle of esotropia was smaller in the observation group (P=0.04). The post-operative angle of esotropia was not statistically significant between botulinum toxin or surgery (P=0.3) though the age of intervention was earlier in the botulinum group (P=0.007). Early intervention did not influence the motor post intervention outcomes between 0-10 prism dioptres of esotropia (P=0.78). Amblyopia (P=0.02) and latent nystagmus (P=0.009) was more common in the observation group.The incidence of EIE in the UK is considerably lower than reported in other population-based studies. The preferred method of treatment was surgical with earlier intervention in those treated with botulinum toxin. An early age of intervention did not influence motor outcomes. Parental choice and amblyopia treatment were reasons cited for conservative management in the observational group.
摘要：
英国的研究报告说，儿童内斜视手术率下降。尚不清楚这是否等同于降低婴儿原发性内斜视（EIE）的发生率。通过英国眼科监督部门（BOSU）进行了一项全国性研究，以确定UKData中EIE的发生率，其特征和管理来自英国12个月内向临床医生提供的新诊断EIE的前瞻性国家观察队列收集。经临床医生确诊的病例，非调节性内斜视≥20棱镜屈光度（PD），在≤12个月时出现，通过BOSU未发现神经系统或眼部异常。在12个月时收集随访数据。收集了年龄数据，性别,种族,出生史,诊断时的年龄，干预年龄，内斜视的角度，折射,弱视的相关特征，内收过度(OEIA)，潜在的眼球震颤和分离的垂直偏差（DVD），管理方法和结果。在2017年10月至2018年10月的观察期间，总共报告了57例EIE的发生率为12,828例活产中的1例，校正后的发生率为9027例活产中的1例，允许估计报告不足。诊断和干预的平均年龄分别为7.05±2.6个月（范围2至12个月）和14.7±4.9（范围6.5-28.1个月）。大多数是白种人，86.5％和52.7％是女性。59.6%为手术管理，仅肉毒杆菌毒素占22.8%，观察到17.5%。患者的就诊年龄差异无统计学意义(P=0.6),性别（P=0.8），早产（P=0.5），剥夺指数(P=0.68)，折射（P=0.7），OEIA（P=0.6），DVD(P=0.7)或随访(P=0.3)三组间。观察组术前内斜视角度较小(P=0.04)。尽管肉毒杆菌组的干预年龄较早（P=0.007），但内斜视的术后角度在肉毒杆菌毒素和手术之间无统计学意义（P=0.3）。早期干预对内斜视0-10棱镜屈光度之间的运动干预后结果没有影响（P=0.78）。弱视(P=0.02)和隐性眼球震颤(P=0.009)在观察组中更为常见。英国EIE的发病率大大低于其他基于人群的研究。优选的治疗方法是在用肉毒杆菌毒素治疗的患者中进行早期干预的手术。早期干预并不影响运动结果。父母选择和弱视治疗是观察组保守治疗的原因。
