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Hu Y, Wang S, Wu L, Xi S, Wen W, Zhao C. Deficits of Visual Cortex Function in Acute Acquired Concomitant Esotropia Patients. Invest Ophthalmol Vis Sci 2023; 64:46. [PMID: 37902746 PMCID: PMC10617634 DOI: 10.1167/iovs.64.13.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/25/2023] [Indexed: 10/31/2023] Open
Abstract
Purpose The purpose of this study was to explore the cortical deficits of patients with acquired concomitant esotropia (AACE) using the resting-state functional magnetic resonance imaging (rs-fMRI) technique. Methods Rs-fMRI signals from 25 patients with AACE and 25 matched controls were collected. The repeated-measures analysis of variance (RM-ANOVA) test and two-sample t-test were used to investigate statistical differences of the amplitudes of low-frequency fluctuation (ALFF) signals and correlation analysis was performed to validate the relationship of signal change and clinical features. Results The AACE group showed decreased ALFF in both hemispheres symmetrically (t = 0.38, P = 0.71), with peak t in both middle occipital gyrus. The ALFF signal from the upper left inferior frontal gyrus was negatively correlated with the age of onset (r = 0.62, P = 0.0008), and the ALFF signal from the right superior temporal gyrus was negatively correlated with the near work hours (r = 0.63, P = 0.0008). The ALFF signal in the left fusiform gyrus was positively correlated with both near (r = 0.48, P = 0.01) and far (r = 0.44, P = 0.03) deviation, whereas it was only positively correlated with far deviation (r = 0.44, P = 0.03) in the right. Besides, the age of onset and the near work hour were independent factors of signal changes. Conclusions Using the ALFF signal of rs-fMRI, we found functional deficits in the primary visual cortex and dorsal pathway in patients with AACE. There were functional changes in the fusiform gyrus, and the greater the deviation angle, the higher the changing level. These findings reveal the association of AACE and the visual center, giving us more clues about the treatment of AACE.
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Affiliation(s)
- Yan Hu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical School, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Shenjiang Wang
- Department of Radiology, Eye and ENT Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Lianqun Wu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical School, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Sida Xi
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical School, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Wen Wen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical School, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Chen Zhao
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical School, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
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Patel AJ, Cavuoto KM. Trends in Etiologies, Demographics, and Neuroimaging in New-Onset Adult Strabismus at an Ophthalmic Emergency Department. J Pediatr Ophthalmol Strabismus 2022; 59:269-273. [PMID: 35192377 DOI: 10.3928/01913913-20220201-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate new-onset strabismus in adults presenting to an ophthalmic emergency department, and to identify which patients require neuroimaging. METHODS This was a retrospective review of electronic medical records of patients 18 years and older who presented to an ophthalmic emergency department between January 1, 2019 and December 31, 2020 with new-onset strabismus. Data regarding demographics, causes, neuroimaging, and resolution were recorded and analyzed. RESULTS Of the 557 patients in the current study, 54.8% were men and the mean age was 57.3 ± 16.7 years (range: 18 to 92 years). Most patients (72.4%) presented with diplopia. Esotropia was the most common ocular misalignment (43.6%) and was more common in women than men (51.6% vs 37.0%, respectively) (P = .001). The most common diagnoses were cranial nerve palsies (66.8%) for both sexes and all age groups, with the most common etiology being microvascular (48.1%) for patients 50 years and older and idiopathic (20.1%) for patients between 18 and 49 years old. The incidence of cranial nerve palsies was significantly higher in older patients (P < .001). Neuroimaging was performed in 58% of patients (n = 323), of whom 37.2% (n = 120) had abnormal findings. The most common abnormal neuroimaging finding was mass for all age groups and sexes (19.2%). Patients with cranial nerve palsy and microvascular etiology had a significantly lower proportion of abnormal neuroimaging findings (P < .001). CONCLUSIONS Most cases of new-onset strabismus in adults presenting to the emergency department were due to cranial nerve palsy, particularly in older patients. Despite high rates of neuroimaging, patients with cranial nerve palsy had mostly normal findings. The current study supports the belief that neuroimaging may be deferred in patients older than 50 years with micro-vascular risk factors. [J Pediatr Ophthalmol Strabismus. 2022;59(4):269-273.].
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Ali MH, Berry S, Qureshi A, Rattanalert N, Demer JL. Decompensated Esophoria as a Benign Cause of Acquired Esotropia. Am J Ophthalmol 2018; 194:95-100. [PMID: 30053478 PMCID: PMC6438619 DOI: 10.1016/j.ajo.2018.07.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine informative clinical and magnetic resonance imaging (MRI) characteristics of patients with symptomatic adult acquired, comitant esotropia due to decompensated esophoria. DESIGN Retrospective, interventional case series. METHODS Setting: Institutional. STUDY POPULATION Patients with decompensated esophoria who developed acute acquired comitant esotropia. OBSERVATION PROCEDURES Ophthalmic examination, stereopsis, and strabismus measurements at distance and near using prism cover tests in diagnostic gaze positions were performed. Patients underwent high-resolution surface coil MRI of extraocular muscles with target fixation, and MRI of the brain. Strabismus surgery was performed under topical anesthesia with adjustable sutures wherever possible. Paired t testing was used to evaluate postoperative changes with 0.05 considered significant. MAIN OUTCOME MEASURE Clinical and MRI characteristics, and surgical outcome of patients with decompensated esophoria. RESULTS Eight cases were identified involving subjects of mean age 29 ± 9.4 (range: 20-48) years having gradually progressive intermittent horizontal, binocular diplopia for 10 months to 3 years. Mean preoperative esotropia was 31 ± 12 Δ at distance and 29 ± 12 Δ at near, although this was intermittent in 5 patients who exhibited enhanced fusional divergence. Neurologic evaluation and MRI of brain, orbits, and extraocular muscles were unremarkable in all cases. Orthotropia was successfully restored in all by standard or enhanced doses of bimedial rectus muscle recession surgery, improving mean stereoacuity from 535 to 68 arc seconds, although 5 patients exhibited 2-14 Δ asymptomatic residual esophoria. CONCLUSION Decompensated esophoria is a benign clinical entity causing acute, acquired, comitant esotropia treatable with enhanced medial rectus recession.
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Affiliation(s)
- Muhammad Hassaan Ali
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Shauna Berry
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Azam Qureshi
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Narisa Rattanalert
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Joseph L Demer
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA; Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA; Biomedical Engineering Interdepartmental Program, University of California, Los Angeles, Los Angeles, California, USA; Neuroscience Interdepartmental Program, University of California, Los Angeles, Los Angeles, California, USA.
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