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Cheung CSY, Wan MJ, Zurakowski D, Kodsi S, Ekdawi NS, Russell HC, Shetty S, Dumitrescu AV, Dagi LR, Shah AS, Hunter DG. A Comparison of Chemodnervation to Incisional Surgery for Acute, Acquired, Comitant Esotropia: An International Study. Am J Ophthalmol 2024; 263:160-167. [PMID: 38447598 DOI: 10.1016/j.ajo.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/24/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE To compare the efficacy of botulinum toxin injections to strabismus surgery in children with acute, acquired, comitant esotropia (ACE), and to investigate factors predicting success. DESIGN International, multi-center nonrandomized comparative study METHODS: Setting: Cloud-based survey. STUDY POPULATION Children aged 2 to 17 years who underwent a single surgical intervention for ACE. INTERVENTIONS Botulinum toxin injection ("chemodenervation" group) or strabismus surgery ("surgery" group). MAIN OUTCOME MEASURES Primary measure: success rate at 6 months in propensity-matched cohort, defined as total horizontal deviation of 10 prism diopters or less with evidence of binocular single vision. Secondary measure: Risk factors for poor outcomes in the full cohort. RESULTS Surgeons from 19 centers contributed. There were 74 patients in the chemodenervation group and 97 patients in the surgery group. In the propensity-matched data (n = 98), success rate was not significantly different at 6 months (70.2% vs 79.6%; P = .2) and 12 months (62.9% vs 77.8%; P = .2), but was significantly lower in the chemodenervation group at 24 months (52% vs 86.4%; P = .015). Irrespective of treatment modality, treatment delay was associated with lower success rates at 6 months, with median time from onset to intervention 4.5 months (interquartile range (IQR): 2.1, 6.7) in the success group and 7.7 months (IQR: 5.6, 10.1) in the failure group (P < .001). CONCLUSIONS In children with ACE, success rate after chemodenervation was similar to that of surgery for up to 12 months but lower at 24 months. Those with prompt intervention and no amblyopia had the most favorable outcomes, regardless of treatment modality.
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Affiliation(s)
- Crystal S Y Cheung
- From the Department of Ophthalmology (C.C, L.D, A.S, D.H), Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology and Vision Science (C.C, M.W), University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael J Wan
- Department of Ophthalmology and Vision Science (C.C, M.W), University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Children's Hospital (D.Z), Harvard Medical School, Boston, Massachusetts, USA
| | - Sylvia Kodsi
- Department of Ophthalmology (S.K), Northwell Health, Great Neck, New York, USA
| | - Noha S Ekdawi
- Department of Ophthalmology (N.E), Wheaton Eye Clinic, Wheaton, Illinois, USA
| | - Heather C Russell
- Faculty of Health Sciences & Medicine, Bond University and Department of Ophthalmology (H.R), Gold Coast University Hospital, Gold Coast, Australia
| | - Shashikant Shetty
- Paediatric Ophthalmology (S.S), Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Alina V Dumitrescu
- Department of Ophthalmology (A.D), University of Iowa, Iowa City, Iowa, USA
| | - Linda R Dagi
- From the Department of Ophthalmology (C.C, L.D, A.S, D.H), Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ankoor S Shah
- From the Department of Ophthalmology (C.C, L.D, A.S, D.H), Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
| | - David G Hunter
- From the Department of Ophthalmology (C.C, L.D, A.S, D.H), Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA.
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Yu X, Pan W, Tang X, Zhang Y, Lou L, Zheng S, Yao K, Sun Z. Efficacy of augmented-dosed surgery versus botulinum toxin A injection for acute acquired concomitant esotropia: a 2-year follow-up. Br J Ophthalmol 2024; 108:1044-1048. [PMID: 37620123 DOI: 10.1136/bjo-2023-323646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND/AIMS This study aims to evaluate the clinical efficacy of botulinum toxin type A (BTXA) injection and augmented-dosed surgery in the treatment of acute acquired concomitant esotropia (AACE), and explore potential risk factors associated with recurrence. METHODS A total of 104 patients diagnosed with AACE between October 2020 and January 2021 were included and voluntarily chose to undergo augmented surgery or BTXA injection. The follow-up assessments ended in November 2022. Multivariable linear regression analysis was used to identify potential factors that influence the dose-response of bilateral medial rectus recession (MRrec). Kaplan-Meier survival analyses and Cox proportional hazards models were performed to evaluate rate and risk factors for AACE relapse. RESULTS A total of 31 AACE patients chose augmented-dosed esotropia surgery, and 73 chose BTXA treatment. During the 2-year follow-up, the surgical group achieved more stable postoperative results with no recurrence of diplopia, while only 68.68% (95% CI 55.31% to 78.79%) patients achieved orthophoria in the BTXA group. For patients undergoing BTXA treatment, hours of near work per day were demonstrated to be a significant risk factor for AACE relapse (HR 1.29, 95% CI 1.00 to 1.67). The dose-response of augmented-dosed bilateral MRrec was positively correlated with preoperative deviation angle (R2=0.833; β=0.043, 95% CI 0.031 to 0.055; p<0.001). CONCLUSION Our findings provided quantitative evidence that augmented-dosed surgery would achieve more stable and favourable surgical outcomes for AACE patients compared with BTXA injection. However, BTXA treatment is still proposed for patients with small deviation angles due to its advantages of reduced trauma, operational simplicity, low cost and quick recovery.
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Affiliation(s)
- Xiaoning Yu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Weiyi Pan
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Xiajing Tang
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Yidong Zhang
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Lixia Lou
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Sifan Zheng
- GKT School of Medical Education, King's College London, London, London, UK
| | - Ke Yao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Zhaohui Sun
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
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Ma RT, Hu DWJ, Zhou LH, Li WP, Li YJ, Yi BX. Botulinum toxin type A in treating early-stage patients with small-angle acute acquired comitant esotropia. Int J Ophthalmol 2024; 17:1094-1101. [PMID: 38895688 PMCID: PMC11144776 DOI: 10.18240/ijo.2024.06.15] [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: 01/03/2024] [Accepted: 03/12/2024] [Indexed: 06/21/2024] Open
Abstract
AIM To investigate botulinum toxin A (BTXA) efficacy on small-angle (≤25Δ) acute acquired concomitant esotropia (AACE) in early-stage patients. METHODS The electronic medical record data of AACE patients during March 2019 and June 2023 were collected in this retrospective and hospital-based cohort study. A total of 72 small-angle AACE patients received BTXA extraocular muscle injection. Patients were grouped by onset-to-treatment time (Group A: ≤6mo, Group B: >6mo). Deviation of esotropia, eye alignment and stereopsis were analyzed at the period of pre/post-injection (1wk, 1, 3, and 6mo). Orthophoria rate at 6mo (horizontal deviation <10Δ and binocular single vision) were considered as outcome index. RESULTS There were no significant baseline differences (P>0.05) between two groups except onset-to-treatment time (2mo vs 11mo, P<0.001). Higher orthophoria rates were in Group A at last follow-up (94.74% vs 73.53%, P=0.013). Post-BTXA deviations of two groups at 1mo showed no difference (P>0.05); while in 3 and 6mo Group A was significantly smaller than group B (all P<0.001). No statistically significant differences were observed among all post-BTXA deviations of near and distance in Group A. In Group B, deviation at 3mo (near: 2Δ vs 0, P<0.001; distance: 4Δ vs 0, P<0.001) and 6mo (near: 6Δ vs 0, P<0.001; distance: 6Δ vs 0, P<0.001) was significant increased compared to deviation at 1wk after treatment. Group A showed better stereopsis recovery in last follow-up compared to Group B (80″ vs 200″, P=0.002). Both groups obtained improved stereopsis after treatment (Group A: 80″ vs 300″, P<0.001; Group B: 200″ vs 300″, P=0.037). CONCLUSION BTXA is effective for AACE with small deviation (≤25Δ) in early stage. Delayed treatment (>6mo) may reduce BTXA efficacy. Early BTXA intervention benefits long-term eye alignment and stereopsis recovery.
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Affiliation(s)
- Run-Ting Ma
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Die-Wen-Jie Hu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Lian-Hong Zhou
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Wen-Ping Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Yuan-Jin Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Bei-Xi Yi
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
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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.
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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
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Li Y, Tong L, Chen Y, Zhang B, Wan M, Yin X, Zhang F. The efficacy of botulinum toxin type A treatment and surgery for acute acquired comitant esotropia. Front Med (Lausanne) 2023; 10:1219419. [PMID: 37601790 PMCID: PMC10436330 DOI: 10.3389/fmed.2023.1219419] [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: 05/09/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Aim To compare the long-term efficiency of botulinum toxin type A (BTXA) injection and surgery on acute acquired comitant esotropia (AACE). Methods This retrospective study enrolled patients with AACE from January 2020 to August 2022. The horizontal angle of deviation pre- and post-treatment was measured. Deviations in BTXA and surgical treatment were compared. The BTXA group was divided into adequate treatment (AT) and inadequate treatment (inAT) subgroup based on the deviation of no more than 4 prism diopters (at near and distance) or temporary exotropia at the 2 week follow-up. The two subgroups were compared to determine the long-term efficacy of BTXA treatment. Results Ninety-two patients with AACE were included. Follow-up was 6 months. The deviations of the surgery and BTXA group were significantly smaller at the 6 month follow-up than at pre-treatment (p < 0.001). The deviation before treatment in the surgery group was larger than in the BTXA groups (p < 0.001) but smaller at the 6 month follow-up (p < 0.001). The deviation was similar in the AT-BTXA and inAT-BTXA subgroups before treatment (p = 0.322 for distance and p = 0.051 for near) but smaller in the AT-BTXA subgroup at 6 month follow-up (p < 0.001 for near and distance). Conclusion Surgery and BTXA successfully treat AACE. Surgery has a more precise and lasting therapeutic effect than BTXA. AACE patients adequately treated with BTXA and with deviations of no more than 4 prism diopters at 2 weeks follow-up had better outcomes.
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Affiliation(s)
- Yipao Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Luyao Tong
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Yuanyuan Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - BinJun Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Minghui Wan
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiangping Yin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Fang Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Song D, Qian J, Chen Z. Efficacy of botulinum toxin injection versus bilateral medial rectus recession for comitant esotropia: a meta-analysis. Graefes Arch Clin Exp Ophthalmol 2023; 261:1247-1256. [PMID: 36322214 DOI: 10.1007/s00417-022-05882-5] [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: 06/05/2022] [Revised: 08/15/2022] [Accepted: 10/20/2022] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVE To compare the effectiveness of botulinum toxin injection (BTX) and bilateral medial rectus recession (BMR) in the treatment of comitant esotropia. METHODS An exhaustive search of the literature from Pubmed, EMBASE, Web of Science, and Cochrane Library databases was carried out until April 2022. No language restrictions were applied. The literature was rigorously screened against eligibility criteria. Odds ratios (ORs) and 95% confidence interval (CI) were calculated. RESULTS A total of 9 articles with 1100 participants were included in this meta-analysis. Three studies compared the effects of BTX to BMR on infantile esotropia, five studies compared the effects of BTX to BMR on acute acquired comitant esotropia, and one study compared the therapeutic effects between BTX and BMR for partially accommodative esotropia. Our pooled results showed that BMR achieved higher overall success rate compared with BTX (OR, 0.49; 95%CI, 0.37-0.64; P < 0.001) and patients subjected to the BTX procedure had higher overall rate of undercorrection (OR, 2.27; 95%CI,1.71-3.02; P < 0.001). No statistical difference in the overall overcorrection rate was observed between the two groups (OR = 0.42, 95% CI: 0.17 ~ 1.03, P = 0.06). Further analysis found that BMR was more effective for infantile esotropia compared to botulinum toxin injections (OR, 0.40; 95%CI, 0.27-0.57; P < 0.001). Nevertheless, the same effect was observed for BMR and BTX in the treatment of acute acquired comitant esotropia (OR, 0.97; 95%CI, 0.50-1.87; P = 0.93). CONCLUSION The present meta-analysis indicated that the BMR procedure achieved a higher success rate and a lower undercorrection rate in patients with comitant esotropia. However, BTX demonstrated similar treatment effects to BMR surgery in the treatment of acute acquired comitant esotropia.
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Affiliation(s)
- Desheng Song
- Department of Ophthalmology, Children's Hospital of Nanjing Medical University, Nanjing, 210023, Jiangsu Province, China.
| | - Jing Qian
- Department of Ophthalmology, Children's Hospital of Nanjing Medical University, Nanjing, 210023, Jiangsu Province, China
| | - Zhijun Chen
- Department of Ophthalmology, Children's Hospital of Nanjing Medical University, Nanjing, 210023, Jiangsu Province, China
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Sefi-Yurdakul N. Clinical features, etiological reasons, and treatment results in patients who developed acute acquired nonaccomodative esotropia. Int Ophthalmol 2023; 43:567-574. [PMID: 35994189 DOI: 10.1007/s10792-022-02458-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/31/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the clinical features, possible etiological reasons, and treatment results in children who developed acute acquired comitant esotropia (AACE) without strabismus in previous years. METHODS Medical records of the patients who were diagnosed with AACE between July 2017 and June 2021 were retrospectively reviewed. The children with ocular and orbital pathology, hypermetropia > 2.00 diopters, and anisometropia > 1.00 diopters were not included in the study. Possible etiological factors that could cause esotropia, treatment results, motor, and sensory functions were investigated. RESULTS The mean age at first admission, and the onset of AACE, was 8.8 ± 2.9 (4-13) years of three female (23.1%) and 10 male (76.9%) cases. The causes of AACE were determined to be occlusion of the eye due to corneal foreign body removal in one (7.7%), emotional stress in one case (7.7%), and excessive close work, on computer and smartphone screens in the other 11 cases (84.6%). Orthotropia was achieved in cases who underwent strabismus surgery (n = 10) and in cases using the prism (n = 2); except for one case, all (92.3%) achieved binocular single vision (100 s/arc stereopsis and fusion) after treatment, while there was no binocular single vision in any of the cases before treatment. CONCLUSIONS Acute acquired comitant esotropia is a rare clinical entity. Successful motor and sensory outcomes can be achieved by strabismus surgery or by prism therapy. It is critical to investigate the patientş with AACE in terms of intracranial pathologies, although rarely seen.
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Affiliation(s)
- Nazife Sefi-Yurdakul
- Başkent University Zübeyde Hanım Hospital-İzmir, Halk Sokak, No: 26, Sahilevleri-Narlıdere, İzmir, Turkey.
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Suwannaraj S, Rojanasaksothron C, Methapisittikul Y, Wongwai P, Yospaiboon Y. Botulinum Toxin Injection versus Extraocular Muscle Surgery for Acute Acquired Comitant Esotropia. Clin Ophthalmol 2023; 17:413-420. [PMID: 36748049 PMCID: PMC9899017 DOI: 10.2147/opth.s401019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Purpose To compare the success rate of extraocular muscle surgery and botulinum toxin injection for treatment in patients with acute acquired comitant esotropia (AACE). Patients and Methods This is a retrospective cohort study in which we treated 34 patients of AACE with botulinum toxin compared with 80 patients who had been treated with surgery. The data included angle of deviation in prism diopter (PD) at baseline and one, three, and six months after treatment. The main outcome was the success rate in each treatment group. Results In the surgery group, mean esodeviation angles at baseline and one, three, and six months after treatment were 50.8 ± 18.3 PD, 4.9 ± 8.3 PD, 4.6 ± 9.5 PD, and 5.5 ± 10.3 PD, whereas those in the botulinum toxin group were 51.2 ± 14.3 PD, 13.9 ± 17.4 PD, 22.0 ± 19.3, and 31.3 ± 23.8 PD, respectively. There was a statistically significant difference in the deviation angles between the two groups (p < 0.001). The success rate in the surgery group at one, three, and six months was 81%, 84%, and 79%, whereas that in the botulinum toxin group was 50%, 27%, and 27%. Conclusion Botulinum toxin injection was not as effective as conventional extraocular muscle surgery in AACE patients. However, the treatment is safe, fast-acting, and improves both cosmetic appearance and quality of life. This may be considered as a chance for patients not preferring surgery.
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Affiliation(s)
- Sirinya Suwannaraj
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chawisa Rojanasaksothron
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yanasiri Methapisittikul
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Phanthipha Wongwai
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yosanan Yospaiboon
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,Correspondence: Yosanan Yospaiboon, KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, 123 Mitraparb Highway, Khon Kaen, 40002, Thailand, Tel +66-4336-3010, Fax +66-4334-8383, Email
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Merino P, Freire M, Yáñez-Merino J, Gómez de Liaño P. Surgical outcomes of acquired acute comitant esotropia. Causes and classification. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:558-564. [PMID: 35871999 DOI: 10.1016/j.oftale.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/22/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To study the results of surgical treatment of acquired concomitant esotropia and its posible causes. METHODS Retrospective study of the patients with acute acquired esotropia that were operated on since 2017. Distance and near horizontal deviation, spherical equivalent and the excessive use of the tablets and smartphones were analyzed. A good sensorial outcome was considered when stereopsis was recovered and good motor outcome if horizontal deviation was ≤10 prism diopters at the end of the follow-up. RESULTS A total of 15 cases were included (60% women), mean age: 29.07 years (86.66% ≥16 years). Mean time since the beginning of the symptoms to the surgery was 23.3 months. Mean horizontal preoperative deviation was 19.73 ± 7.2 pd at near and 22.93 ± 7.3 dp at distance decreasing to 3.33 ± 3.8 pd at near and 3.86 ± 3.9 pd at distance (P < .001). The 66.6% had diplopía. The 46.66% had decompensated esophoria or microesotropia, 86,66 % myopia and the 33.33% referred excesive use of the tablets and smartphones. The medial rectus recession were done in 10 cases. A good motor outcome was obtained in the 93.33% of the cases and sensorial outcome in the 53.3% without diplopía. CONCLUSION Surgery was an excellent treatment to resolve the deviation and diplopia. The esophorias and microesotropias represented near the half of the cases and the excesive use of the tablets and smartphones were the third part of the sample. Most of the patients had myopia.
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Affiliation(s)
- P Merino
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid, Spain.
| | - M Freire
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid, Spain
| | - J Yáñez-Merino
- Departamento de Oftalmología, Hospital Miguel Servet, Zaragoza, Spain
| | - P Gómez de Liaño
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid, Spain
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Huang X, Meng Y, Hu X, Zhao Y, Ye M, Yi B, Zhou L. The Effect of Different Treatment Methods on Acute Acquired Concomitant Esotropia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5001594. [PMID: 35502413 PMCID: PMC9056260 DOI: 10.1155/2022/5001594] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/30/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022]
Abstract
Objective The application of botulinum toxin type A (BTXA) in the treatment of paralytic strabismus has been recognized, but there are few studies on the treatment of acute acquired comitant esotropia (AACE). This study was aimed to investigate the clinical characteristics of AACE and compare the therapeutic effects of BTXA and traditional surgery. Methods 78 patients with AACE in Renmin Hospital of Wuhan University between March 2019 and March 2021 were reviewed. The relevant medical records of the patients were collected, and they were divided into surgical group (n = 46) and botulinum toxin type A (BTXA) group (n = 32) according to different treatment approaches. The surgical group was treated with squint correction, whereas the BTXA group was treated with microinjection of BTXA in MR. Eye alignment, esotropia, stereopsis, and complications were examined before and after treatment in both groups. Results The refractive status of 78 patients with AACE was mostly myopic refractive error. In general, the angle of esotropia at distance was larger than which at near, with a statistically significant difference. At follow-up assessments of 1 week, 1 month, 3 months, and 6 months after treatment, the total effective rates of the surgical group and the BTXA group were 100% and 90.48%, respectively. The residual angle of esotropia of both groups was lower after treatment. Additionally, the incidence rate of complications in the BTXA group was significantly lower than that in the surgical group. Conclusion AACE occurs mostly in people with myopic refractive errors and is associated with prolonged near work. Besides surgical treatment, micro-injection of BTXA is also an effective and safe treatment for AACE.
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Affiliation(s)
- Xiaoqi Huang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yanfang Meng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xuemin Hu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yijia Zhao
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Meihong Ye
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Beixi Yi
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Lianhong Zhou
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
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Clinical findings of acute acquired comitant esotropia in young patients. Jpn J Ophthalmol 2021; 66:87-93. [PMID: 34655005 DOI: 10.1007/s10384-021-00879-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to identify the characteristics of acute acquired comitant esotropia (AACE) in young patients from a single institution; and clarify their relationship with the excess use of digital devices. STUDY DESIGN Retrospective, observational. METHODS We extracted the clinical charts of patients aged between 5 and 35 years who presented at the Hamamatsu University Hospital with AACE symptoms from January 1, 2015 to December 31, 2018. The age of onset, angle of deviation, refractive errors, history of near work, including excess smartphone use, and treatment modality were retrieved. Patients were divided into three groups: CHILD (aged 5-12 years), JUNIOR (aged 13-17 years), and ADULT (aged 18-35 years) and statistically analyzed with Kruskal-Wallis test. RESULTS Forty-one patients were retrieved, with a mean age at onset of 15.8 (5-28) years; eight in the CHILD group, 23 in the JUNIOR group, and 10 in the ADULT group. Refractive errors and age of patients were correlated, but were not significantly different among groups. The mean angle of deviation at distance was 28.0 ± 12.8 prism diopters (PD) and 28.6 ± 17.2 PD at near. The CHILD group showed the largest near-distant dissociation. History of excessive near work was found in all groups. CONCLUSION AACE was most commonly found in the JUNIOR group, especially those aged 15-16 years. AACE may encompass multiple diseases; using common diagnostic criteria and asking common questions regarding digital device usage is necessary to clarify the influence of digital device usage, and a multicenter prospective study is recommended.
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Meng Y, Hu X, Huang X, Zhao Y, Ye M, Yi B, Zhou L. Clinical characteristics and aetiology of acute acquired comitant esotropia. Clin Exp Optom 2021; 105:293-297. [PMID: 33926368 DOI: 10.1080/08164622.2021.1914510] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CLINICAL RELEVANCE Acute acquired comitant esotropia (AACE) is characterised by the acute onset of diplopia which affects work and life.Background: To describe the clinical characteristics and discuss the aetiology of acute acquired comitant esotropia.Methods: The medical records of 51 patients with AACE were retrospectively analysed, and their age, occupation, daily average time spent on near work, angle of deviation, refractive error and aetiology were analysed.Results: The age at onset of AACE was eight to 55 years. Thirty-nine patients were aged 12 to 36 years (76.5%), and 42 patients (82.4%) were myopic. The angle of deviation was 20Δ (12Δ to 35Δ) during near fixation and 25Δ (18Δ to 40Δ) during distance fixation. The deviation during distance fixation was larger than that during near fixation, the difference being statistically significant (p < 0.001). The daily average time of near work before onset was 9.0 h (8.0 h to 10.0 h); 35 patients (68.6%) spent more than 8 h performing near work. Their occupations included students, accountants, information technology staff, and those who required electronic use for a long time. There is no correlation between the angle of deviation and the time of near work (p > 0.05). Among the 51 patients, three had intracranial diseases. Diplopia resolved in 47 cases following treatment. The angle of deviation post-treatment was 0Δ (0Δ to 5Δ) during near and 0Δ (0Δ to 3Δ) during distance fixation.Conclusion: AACE occurs mostly in myopic older children and adults. The onset of esotropia is related to long-term near work. AACE patients mostly present an angle of deviation that is larger during distance than near fixation. Intracranial disease is an infrequent but important cause of AACE that needs to be excluded in all cases.
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Affiliation(s)
- Yanfang Meng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xuemin Hu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaoqi Huang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yijia Zhao
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Meihong Ye
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Beixi Yi
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lianhong Zhou
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
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Shi M, Zhou Y, Qin A, Cheng J, Ren H. Treatment of acute acquired concomitant esotropia. BMC Ophthalmol 2021; 21:9. [PMID: 33407264 PMCID: PMC7788946 DOI: 10.1186/s12886-020-01787-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/21/2020] [Indexed: 11/22/2022] Open
Abstract
Background The treatment efficacy of botulinum toxin bilateral medial rectus injections for acute acquired concomitant esotropia (AACE) in adult is not clear. We characterize the effects of botulinum toxin injection in the treatment of AACE, especially in patients over 14 years old, and compared it with surgical treatment. Methods In this prospective, nonrandomized, controlled clinical study, patients with AACE in our hospital from March 2017 to March 2020 elected to receive bilateral medial rectus injections of botulinum toxin or to undergo extraocular muscle surgery. Ocular position and stereopsis were evaluated before and after treatment. Results A total of 60 patients were treated: 40 patients in the botulinum toxin group, and 20 patients in the surgery group. The botulinum toxin group included 31 cases ≥ 14 years of age and 9 cases < 14 years of age. After 1–3 botulinum injections, the cumulative initial success rate was 95% (38/40), and the recurrence rate was 22.5% (9/40). Nine children < 14 years of age were treated successfully, without recurrence. In the surgery group, the initial success rate after surgery was 75% (17/20), and the recurrence rate was 20% (4/20). There was no significant difference between groups in the rate of success rate or the rate of recurrence (P > 0.05). Conclusion The injection of botulinum toxin has a good effect on AACE in adults and children. The outcomes achieved with injected botulinum toxin are similar to those achieved with surgery. Trial registration ChiCTR, ChiCTR2000032544. Registered May 2, 2020, Retrospectively registered.
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Affiliation(s)
- Minghua Shi
- Department of Strabismus and Pediatric Opthalmology, Wuhan Aier Eye Hospital(Hanyang), Wuhan, 430020, China.
| | - Yuanxiang Zhou
- Department of Strabismus and Pediatric Opthalmology, Yueyang Aier Eye Hospital, Yueyang, 414000, China
| | - Aijiao Qin
- Department of Strabismus and Pediatric Opthalmology, Wuhan Aier Eye Hospital(Hanyang), Wuhan, 430020, China
| | - Jing Cheng
- Department of Strabismus and Pediatric Opthalmology, Wuhan Aier Eye Hospital(Hanyang), Wuhan, 430020, China
| | - Hongxing Ren
- Department of Strabismus and Pediatric Opthalmology, Wuhan Aier Eye Hospital(Hanyang), Wuhan, 430020, China
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Wangtiraumnuay N, Surukrattanaskul S, Surakiatchanukul T, Masaya-Anon P, Hiriotappa J. Outcomes of pediatric accommodative esotropia with botulinum toxin A treatment in Thailand. Strabismus 2021; 29:26-33. [PMID: 33404269 DOI: 10.1080/09273972.2020.1871379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Accommodative esotropia is a condition commonly encountered by pediatric ophthalmologists. Patient with accommodative esotropia wear hyperopic glasses to decrease accommodation which occasionally provide them with good vision without glasses. Children are known to have limited compliance with glasses and patching. Their limited cooperation can also lead to variability in angle measurement across visits and defer surgery. To cope with these challenges, our team offered botulinum toxin injection to the medial rectus as an optional treatment while waiting for compliance and deferring the surgery. This is retrospective study including data from 114 accommodative esotropia patients who were injected with botulinum toxin into the medial rectus between 2010 and 2017. Of these, 102 patients met the inclusion criteria. Almost half of the patients were boys (47.06%). The average angle deviation before injection was 40 prism diopters (PD). The post-injection angle averaged at 11 PD at 2 weeks, 19 PD at 3 months, and 25 PD at 6 months. At 6 months, 51 patients (50.00%) had satisfactory results, 17 (16.67%) had excellent results (ortho to esotropia < 10 PD) and 34 (33.33%) had small angle esotropia (esotropia 11-20 PD). All complications including ptosis (37.25%), exotropia (11.76%), and hypertropia (4.9%) were reversible. Botulinum toxin injection into the medial rectus for pediatric esotropia showed satisfactory outcomes in 50% of patients with minimal complications. The study showed no significant association of good outcomes with age at onset, age during injection, status of development, status of amblyopia, refractive error, and angle of deviation as analyzed by the statistical package for social sciences.
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Affiliation(s)
| | | | | | | | - Juthathip Hiriotappa
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok
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Zhang P, Zhang Y, Gao L, Yang J. Comparison of the therapeutic effects of surgery following prism adaptation test versus surgery alone in acute acquired comitant esotropia. BMC Ophthalmol 2020; 20:303. [PMID: 32703185 PMCID: PMC7379764 DOI: 10.1186/s12886-020-01574-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the therapeutic effects of surgery following prism adaptation test versus surgery alone in acute acquired comitant esotropia (AACE). METHODS A total of 46 patients with AACE were enrolled in this retrospective study. Among them, 26 patients underwent surgery following prism adaptation test (combination group) and 20 patients underwent surgery alone (surgery group). The following parameters were evaluated including success rate, distant and near deviation angles, visual function, and near stereoacuity. RESULTS There were no significant differences in success rate between the combination group and surgery group at post-treatment 12 months (96.15% vs. 90.00%, p > 0.05). The postoperative distant and near deviation angles in two groups were significantly lower than that before surgery (p < 0.05). In addition, the numbers of patients with stereopsis postoperatively in two groups were significantly higher than that before surgery (all p < 0.05). Moreover, the numbers of patients with stereopsis and central stereopsis in the combination group were significantly higher than that in the surgery group postoperatively. At post-treatment 12 months, one (3.85%) case recurred in combination group and three (15.00%) cases in the surgery group. No complications were observed in the two groups. CONCLUSIONS Both approaches had therapeutic benefit in AACE. Surgery following prism adaptation test had better treatment benefits than surgery alone in improving binocular function and reducing recurrence rate.
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Affiliation(s)
- Peng Zhang
- Department of Ophthalmology, Jinan 2nd People's Hospital, No.148, Jingyi Road, Huaiyin District, Jinan, 250001, China
| | - Ying Zhang
- Department of Ophthalmology, Jinan 2nd People's Hospital, No.148, Jingyi Road, Huaiyin District, Jinan, 250001, China
| | - Lei Gao
- Department of Ophthalmology, Jinan 2nd People's Hospital, No.148, Jingyi Road, Huaiyin District, Jinan, 250001, China
| | - Jun Yang
- Department of Ophthalmology, Jinan 2nd People's Hospital, No.148, Jingyi Road, Huaiyin District, Jinan, 250001, China.
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