Clinical features of basic acquired nonaccommodative esotropia requiring surgery
Reviewed by Fiona Rowe

Basic acquired nonaccommodative esotropia (BANAET) is a concomitant esotropia occurring after the age of six months without significant refractive error or accommodative element. Esotropia is similar for both near and distance and children have prior binocular single vision. The purpose of this study was to review the preoperative clinical features in these patients who have had strabismus surgery over a 10-year period. Two-thousand-and-twelve children were grouped into: (1) managed with one surgery (76.1%), (2) managed with two surgeries (16.3%), and (3) managed with three or more surgeries (7.6%). Mean age at first surgery was 18.9 ±15.6 years. There were 57.1% male and 42.9% female. Most had first surgery at ages 3–6 years. Preop angle of deviation was a mean 36.8 ±17.2PD at distance and 37.3 ±17.4PD at near. Preop spherical equivalent was 0.31 ±1.44D right eye and 0.34 ±1.33D left eye. Mean visual acuity was better in group 1 than groups 2 and 3. Angle of deviation was significantly less for group 1. Amblyopia was present in 18.1% for group 1, 20.2% for group 2, and 26.7% for group 3. Bilateral amblyopia was less for group 1 and amblyopia was most frequent for group 3. Less cylindrical refractive error was in group 1. The authors recommend attention to refractive error in the differential diagnosis of BANAET vs. accommodative esotropia with +2.0D as a cut-off. They consider the prism adaptation test to identify the maximum angle when planning surgery, particularly as there are less favourable clinical features in those needing multiple surgeries.

Basic acquired nonaccommodative esotropia patients managed with surgery; a study of 2102 patients.
Akbari MR, Alghurab A, Azizi E, Khorrami-Nejad M.
STRABISMUS
2023;31(4):281–9.