Bothun, Erick D.Shainberg, Marla J.Christiansen, Stephen P.Vanderveen, Deborah K.Neely, Dan E.Kruger, Stacey J.Cotsonis, GeorgeLambert, Scott R.Infant Aphakic Treatment Study2024-05-302024-05-302022Bothun ED, Shainberg MJ, Christiansen SP, et al. Long-term strabismus outcomes after unilateral infantile cataract surgery in the Infant Aphakia Treatment Study. J AAPOS. 2022;26(4):174.e1-174.e4. doi:10.1016/j.jaapos.2022.05.003https://hdl.handle.net/1805/41091Purpose: 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.en-USPublisher PolicyCataract extractionEsotropiaStrabismusExotropiaArticle