1
|
Cai J, Li X, Li Q, Cai Y, Chen J. Clinical characteristics of acute acquired concomitant esotropia before and after the COVID-19 pandemic: a retrospective analysis. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06416-x. [PMID: 38386058 DOI: 10.1007/s00417-024-06416-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/24/2024] [Accepted: 02/11/2024] [Indexed: 02/23/2024] Open
Abstract
PURPOSE This study aimed to observe the clinical characteristics of acute acquired concomitant esotropia (AACE) patients in recent five years and to examine the changes in the proportion of AACE cases before and after the COVID-19 pandemic. METHODS A retrospective study included 148 patients who underwent strabismus correction surgery for AACE between January 1, 2017, and December 31, 2021. The study analyzed the changing proportion of AACE cases before and after the COVID-19 pandemic and analyzed its clinical characteristics. RESULTS Abnormalities in the worth 4 dot examination (both distance and near) were present in 134 cases (90.54%) before surgery, while 140 cases (94.59%) showed normal results after surgery. Near stereoacuity was present in 135 cases (91.22%). The near and distance deviations were (55.01 ± 18.77) PD and (57.30 ± 17.64) PD, respectively, and there was no significant difference between the two (p = 0.279). There were significant differences in the ratio of refractive status among different age groups (p < 0.001), while no statistically significant difference was observed in the ratio of refractive status for near deviation (p = 0.085) or distance deviation (p = 0.116). The proportion of AACE cases after the COVID-19 pandemic was significantly higher than that before the COVID-19 pandemic (p = 0.042). There was no statistically significant difference in the clinical characteristics between the two groups (p > 0.05). CONCLUSIONS Myopia is the most common refractive status in AACE. More than half of patients had occupations that involved long hours of close work. The proportion of AACE cases increased significantly after the COVID-19 pandemic.
Collapse
Affiliation(s)
- Jie Cai
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Xia Li
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Qin Li
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Ying Cai
- Nanning Aier Eye Hospital, Nanning, 530001, Guangxi, China
| | - Jinmao Chen
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
| |
Collapse
|
2
|
Hayashi R, Hayashi S, Nishimura T, Machida S. Conformation of Horizontal Extraocular Muscle Insertions in Acute Acquired Concomitant Esotropia Induced by Excessive Digital Device Usage. Clin Ophthalmol 2024; 18:41-47. [PMID: 38205266 PMCID: PMC10778159 DOI: 10.2147/opth.s440322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/02/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose Acute acquired concomitant esotropia induced by excessive digital device usage, especially smartphones (SAACE), has been increasing over the past few years. Convergence spasm induced by excessive near work has been suggested as a mechanism. Anatomical differences could also potentially contribute to SAACE onset. The present study investigated the conformation of horizontal recti between SAACE patients and normal subjects. Patients and Methods In 15 SAACE patients (SAACE group), the distances between the limbus and insertion of the horizontal recti (LI distance) and the widths of horizontal recti on the insertion (insertion width) were measured. The control group consisted of 30 patients who underwent retinal detachment surgery. Differences in LI distances and insertion widths were compared between SAACE and control groups. Results While there were no differences between the two groups for LI distances and insertion widths of lateral recti, there were significantly shorter LI distances for the medial recti in the SAACE group (P<0.05). Moreover, the SAACE group tended to exhibit larger insertion widths of the medial recti. Medial/lateral ratio of LI distances were significantly lower and insertion widths were significantly higher in the SAACE compared to the control group (P<0.05). Conclusion Based on the observations of more anterior insertion and larger muscle widths, this suggests there are stronger forces of medial recti in SAACE. In addition to excessive accommodation followed by increases in medial recti tonus, the results also suggest that an anatomical imbalance between lateral and medial recti contributes to esotropia onset following excessive near work.
Collapse
Affiliation(s)
- Rijo Hayashi
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Saitama, Japan
| | - Shimmin Hayashi
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Saitama, Japan
- Lively Eye Clinic, Soka, Saitama, Japan
| | - Tomoharu Nishimura
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Saitama, Japan
| | - Shigeki Machida
- Department of Ophthalmology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Saitama, Japan
| |
Collapse
|
3
|
Cai J, Lai WX, Li X, Li Q, Cai Y, Chen JM. Analysis of independent risk factors for acute acquired comitant esotropia. Int J Ophthalmol 2023; 16:1854-1859. [PMID: 38028509 PMCID: PMC10626352 DOI: 10.18240/ijo.2023.11.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/13/2023] [Indexed: 12/01/2023] Open
Abstract
AIM To explore the risk factors for acute acquired comitant esotropia (AACE). METHODS A retrospective cohort study was conducted by analyzing 83 patients (case group) with AACE who underwent strabismus correction surgery from January 1, 2021 to June 30, 2022. Totally 73 outpatient volunteers were recruited during the same period as the normal control group. The case group's binocular vision time, near and distance esotropia angle, and near stereo vision function were recorded, and the age, gender, refractive status, and best-corrected visual acuity (BCVA) of both groups were analyzed. Additionally, multiple logistic regression analysis was conducted using an eye usage condition questionnaire to determine the independent risk factors for AACE. RESULTS In the case group, 61 patients (73.49%) had myopia, with a mean equivalent spherical power (SE) of -3.35±3.31 D (range: +2.75 to -10.62 D) of the right eye and -2.87±3.35 D (range: +2.75 to -11.12 D) of the left eye. The average duration of diplopia in the case group was 29.83±35.72mo, of which 80 patients (96.39%) were primarily with distance diplopia. The near and distance esotropia angle after wearing glasses were 52.36±20.95 prism degree (PD) and 56.71±19.54 PD, respectively, and there was no statistically significant difference between the two (t=1.38, P=0.169). The incidence of improper glasses wearing and unhealthy eye habits in the case group was significantly higher than those in the control group (P<0.05). Close-up work without glasses [β=2.30, odds ratio (OR)=10, 95% confidence interval (CI) 2.35-42.51, P=0.002] and near work in supine position (β=1.80, OR=6.02, 95%CI 3.29-11.02, P<0.001) were independent risk factors for AACE. CONCLUSION Patients with AACE mainly present with distance diplopia, and there is a high degree of variation in myopia. Near work without wearing glasses and in supine position are independent risk factors for AACE.
Collapse
Affiliation(s)
- Jie Cai
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Wei-Xia Lai
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530022, Guangxi Zhuang Autonomous Region, China
| | - Xia Li
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Qin Li
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ying Cai
- Nanning Aier Eye Hospital, Nanning 530001, Guangxi Zhuang Autonomous Region, China
| | - Jin-Mao Chen
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| |
Collapse
|
4
|
Cassano F, Procoli U, Ferrari LM, Buonamassa R, Zaccaro F, Boscia F, Alessio G. Acute acquired concomitant esotropia: May COVID-19 lockdowns have changed its presentation? Eur J Ophthalmol 2023:11206721231213415. [PMID: 37956466 DOI: 10.1177/11206721231213415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
PURPOSE To evaluate the effects of COVID-19 lockdown in Italy on the features of Acute Acquired Concomitant Esotropia (AACE). SUBJECTS Patients of the Polyclinic Hospital of Bari diagnosed with AACE between January 2018 and December 2021, subdivided in pre-lockdown group - diagnosed before March 2020 - and post-lockdown group. METHODS Medical records were reviewed, and statistical analysis performed. Deviation size was assessed in the 9 cardinal positions of gaze with refractive correction. Wilcoxon test for unpaired samples was used to compare data of age, near maximum deviation and best corrected visual acuity (BCVA) for each eye; Student's t test was used to compare far maximum deviation, difference far/near maximum deviation and spherical equivalent data. Fisher exact test was used to compare subtype cases (Bielschowsky vs Non-Bielschowsky) in the two groups. A p-value lower than 0.05 was considered statistically significant.The primary outcome measure was the difference in AACE subtypes between the two groups. RESULTS Nineteen patients were included, of which 12 males (63.2%); 7 belong to the pre-lockdown group and 12 to the post-lockdown group. The difference in types between the two groups proved to be statistically significant (p = 0.01977).The differences in the mean of age, right BCVA, right spherical equivalent and mean spherical equivalent between the two groups proved to be statistically significant (p < 0.05). CONCLUSIONS After the COVID-19 pandemic, the profile of the typical patient with AACE has probably changed, and now it is more probably myopic and elderly than before. Thus, we observed an increase in the Bielschowsky subtype.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
MacKinnon JR, McCulloch J. Comment on: Clinical characteristics and risk factors of acute acquired concomitant esotropia in last 5 years: a retrospective case-control study. Eye (Lond) 2023; 37:3296. [PMID: 36928223 PMCID: PMC10018579 DOI: 10.1038/s41433-023-02501-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/07/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Affiliation(s)
- Jane R MacKinnon
- Ophthalmology Department, Raigmore Hospital, Inverness, IV2 3UJ, Scotland, UK.
| | - Jean McCulloch
- Ophthalmology Department, Raigmore Hospital, Inverness, IV2 3UJ, Scotland, UK
| |
Collapse
|
7
|
Augmented-Dose Unilateral Recession-Resection Procedure in Acute Acquired Comitant Esotropia. Ophthalmology 2022; 130:525-532. [PMID: 36572256 DOI: 10.1016/j.ophtha.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/28/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To compare the surgical amount of unilateral medial rectus recession and lateral rectus resection (RR) in patients with acute acquired comitant esotropia (AACE) versus common forms of esotropia and to provide dose-response reference for surgical planning in AACE. DESIGN Retrospective study. PARTICIPANTS Consecutive patients who underwent unilateral RR for AACE or common forms of esotropia correction from January 2018 to January 2022. Only patients who achieved motor and sensory success with a minimum follow-up of 3 months were analyzed. METHODS Group differences in the amount of medial rectus (MR) recession and lateral rectus (LR) resection were analyzed using multivariate regression models. Surgical dose responses in AACE were analyzed using multivariable regression models. Regression models were performed with and without adjustment for clinical confounders. Piecewise analysis was used to detect segmented results. MAIN OUTCOME MEASURES Group difference in surgical amount and dose responses of unilateral RR in AACE. RESULTS Fifty-four patients with AACE and 98 patients with common forms of esotropia were included. To correct comparable deviations, surgical amount performed was significant larger in AACE patients, with the adjusted group differences of 0.49 mm (95% confidence interval [CI], 0.34-0.65 mm; P < 0.001) in MR recession and 1.68 mm (95% CI, 1.25-2.11 mm; P < 0.001) in LR resection in patients with deviation < 40 prism diopters (Δ) and with a group difference of 1.22 mm (95% CI, 0.76-1.68 mm; P < 0.001) in LR resection in those with deviation ≥ 40 Δ. In AACE patients, in the adjusted model taking into account the intercept, dose responses of MR recession and LR resection in patients with deviation < 30 Δ were 5.11 Δ/mm (95% CI, 0.98-9.23 Δ/mm; P = 0.02) and 2.51 Δ/mm (95% CI, 0.57-4.45 Δ/mm; P = 0.02), respectively, and for those with deviation ≥ 30 Δ, the dose response of additional LR resection was 5.48 Δ/mm (95% CI, 4.56-6.40 Δ/mm; P < 0.001) to correct remaining deviation beyond 30 Δ. CONCLUSIONS These findings provide quantitative evidence that augmented-dose unilateral RR should be performed in AACE for favorable surgical outcomes. The new surgical dose calculation proposed provides reference for surgical planning. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Collapse
|
8
|
Gupta N, Pradhan KR, Chopra G, Khadka S. A rare presentation of esotropia in high myopia in a young adult: a case report. Oxf Med Case Reports 2022; 2022:omac137. [PMID: 36540837 PMCID: PMC9759939 DOI: 10.1093/omcr/omac137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 12/23/2022] Open
Abstract
Esotropia in myopia is an uncommon occurrence. Most common cause of esotropia in high myopic elderly is Heavy Eye Syndrome. An uncommon cause in young adults is Acute Acquired Comitant Esotropia often associated with excessive indulgence in near work. A 21 year old male patient presented with diplopia for one year, more for distance than near and spent more than 8-10 hours for near tasks. Unaided visual acuity in BE was 2/60 and was 6/9 in RE and 6/6 in LE with correction. Prism base cover test revealed 25 BO PD for distance and 20 BO PD for near. Diplopia was seen in all position of gaze. Right Eye Lateral rectus resection 8 mm was done and HPE report revealed features of Lateral rectus Muscle atrophy. It is important to understand the pathogenesis of this entity and consider other possible causes of esotropia in myopia. Key words: Myopia, Esotropia, Comitant, Diplopia.
Collapse
Affiliation(s)
- Namrata Gupta
- Correspondence address. Pediatric Ophthalmology and Strabismus Department, Matrika Eye Center, Kathmandu 44600, Nepal. Tel: +977-9851087655; E-mail:
| | | | - Geeta Chopra
- Histopathology Department, Metropolis Healthcare Pvt. Ltd., New Delhi, India
| | - Sajina Khadka
- Refraction Unit, Matrika Eye Center, Kathmandu, Nepal
| |
Collapse
|
9
|
Guo RL, Ai LK, Zhao SQ. Clinical features and treatment of near-work-related acquired esotropia. Int J Ophthalmol 2022; 15:1338-1343. [PMID: 36017050 DOI: 10.18240/ijo.2022.08.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the characteristics of near-work-related esotropia and the clinical efficacy of botulinum toxin type A (BTXA) injection therapy on it. METHODS A total of 107 patients aged 15-57y with near-work-related esotropia were taken as the BTXA-treated group, and 30 other peers without near-work-related esotropia were included in the control group. All participants were refractive corrected to analyse the clinical characteristics of near-work-related esotropia. All subjects were examined including Worth4 spot examination, stereoscopic vision, strabismus angle, accommodative convergence to accommodation ratio (AC/A), far and near positive and negative convergence, positive and negative fusion range, positive and negative relative accommodation. Clinical efficacy was evaluated at a period of 10mo follow-up. RESULTS The distant and near stereopsis were found in 84.9% and 77.5% of patients in the BTXA-treated group, respectively. In the control group, all patients had distant and near stereopsis. The incidence of taking off one's glasses to see close objects was significantly higher in the BTXA-treated group than in the control group (P<0.05). The BTXA-treated group showed a smaller range of in-fusion (9.84±5.72)° than the control group (22.04±8.71)° (P<0.05). The near esotropia angle of the BTXA-treated group (17.08±11.98)Δ was significantly smaller than the distant esotropia angle (19.07±11.68)Δ (P<0.05). Ten months after injection, the diplopia and esotropia of most patients underwent improvements after treatment (P<0.05). CONCLUSION This study reveals that the accommodation function and the habit of near work without wearing spectacles are associated with near-work-related esotropia, while the length of time for near work and the onset time are independent of near-work-related esotropia. Additionally, BTXA injection therapy plays a vital role in relieving diplopia and restoring eye position.
Collapse
Affiliation(s)
- Rui-Lin Guo
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing 100730, China
| | - Li-Kun Ai
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing 100730, China
| | - Shi-Qiang Zhao
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing 100730, China
| |
Collapse
|