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Israeli A, Bar-Asher T, Mezer E. Characteristics and Trends of Strabismus Surgeries at a Tertiary Hospital Over 2 Decades - What Can Be Learned for Years to Come? J Binocul Vis Ocul Motil 2024; 74:84-90. [PMID: 38924773 DOI: 10.1080/2576117x.2024.2364946] [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: 02/01/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To analyze characteristics and trends of strabismus surgeries in an Israeli hospital over 2 decades. METHODS A descriptive, retrospective study including all strabismus surgeries (666) performed during 2000-2019 at an Israeli tertiary hospital. Electronic medical records (EMRs) were directly retrieved to produce an anonymized database. RESULTS No trends were evident for age, sex, or ethnicity (p = .294, 0.914 and p = .167, respectively). The mean number of horizontal muscles remained stable, while an increase was noted in the mean number of muscles operated on to repair vertical strabismus (p < .0001). Among acquired cases, a 2.67-fold increase was noted in the proportion of spontaneous strabismus and a decrease of traumatic causes to a third (p < .001). An increase was noted in the proportion of exotropia among horizontal strabismus corrections (p = .022), and esotropia correction techniques distribution changed (p = .004). Reoperations comprised a third of all cases during both decades (p = .198). Reoperations were more prevalent among younger and Jewish patients (p < .001 and p = .024, respectively). Techniques to correct esotropia and exotropia differed significantly between primary surgeries and reoperations (p < .00001 each). CONCLUSIONS The complexity of surgical techniques increased over time. Ethnic minorities were less prone to reoperations.
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Affiliation(s)
- Asaf Israeli
- Bruce and Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Tel Aviv Medical Center, Tel Aviv, Israel
| | - Tom Bar-Asher
- Bruce and Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Eedy Mezer
- Bruce and Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Department of Ophthalmology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
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Sharma R, Tibrewal S, Majumdar A, Rath S, Ganesh S. Acquired comitant esotropias - comparison of surgical outcomes of accommodative vs non-accommodative types. Strabismus 2023; 31:293-305. [PMID: 38086747 DOI: 10.1080/09273972.2023.2281979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Purpose: To compare the motor and sensory outcomes of strabismus surgery and the factors affecting surgical success in acquired acute non-accomodative esotropia (ANAET) and partially accommodative refractive esotropia (pARET). Methods: A retrospective chart review of patients with ANAET and pARET who underwent unilateral or bilateral horizontal rectus muscle surgery between January 2020 and December 2021 was conducted. Patients with postoperative follow-up of at least six weeks were included. Patients with pattern deviation, lateral incomitance, and near-distance disparity were excluded. Motor success was defined as a postoperative deviation within eight prism diopters of orthophoria. Sensory success was defined as presence of binocular single vision (BSV) for both distance and near (Worth four dot test). The effect of factors like age at onset, age at surgery, amblyopia before surgery, duration of squint before treatment, presence or absence and magnitude of vertical deviation, preoperative angle of deviation, and spherical equivalent on the motor and sensory success in each group were analyzed and compared. Results: 38 patients with ANAET and 33 patients with pARET were included. The mean age of onset of esotropia was 8.55 ± 4.65 years and 4.39 ± 2.27 years (p < .001) and the mean age at surgery was 10.62 ± 4.99 years and 7.89 ± 2.84 years (p = .006) in the ANAET and the pARET group respectively. The mean duration of the final follow-up was 38.51 weeks in the ANAET and 48.68 weeks in the pARET group (p = .089). Patients were successfully aligned for both distance and near in 81.5% of patients in the ANAET and 78.9% of patients in the pARET group at the final follow-up (p. 0.775). A BSV for both distance and near at the final follow-up was seen in 81.2% vs 66.6% of patients in the ANAET and the pARET group respectively (p = .25). A good near stereoacuity (<120 arcsecs) was seen in 60.6% and 41.9% of the ANAET and the pARET groups respectively (p = .175). The percentage of patients in the ANAET group who had orthophoria, any esodeviation, and any exodeviation for distance at the final follow-up was 63.1%, 34.2% and, 2.6%. The percentage of patients in the pARET group in similar categories was 36.3%, 42.4% and, 21.2%. None of the demographic and preoperative factors were found to affect the surgical outcomes in the two groups. Conclusions: The motor and sensory outcomes were similar in the two groups. A higher proportion of ANAET patients remained orthophoric during the follow-up. The patients in the pARET group showed a tendency toward exodrift.
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Affiliation(s)
- Richa Sharma
- Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Dr Shroff's Charity Eye Hospital, New Delhi
| | - Shailja Tibrewal
- Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Dr Shroff's Charity Eye Hospital, New Delhi
| | - Atanu Majumdar
- Department of Biostatistics, Dr Shroff's Charity Eye Hospital, New Delhi
| | - Soveeta Rath
- Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Dr Shroff's Charity Eye Hospital, New Delhi
| | - Suma Ganesh
- Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Dr Shroff's Charity Eye Hospital, New Delhi
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Akbari MR, Alghurab A, Azizi E, Khorrami-Nejad M. Basic acquired nonaccommodative esotropia patients managed with surgery; a study of 2102 patients. Strabismus 2023; 31:281-289. [PMID: 37982308 DOI: 10.1080/09273972.2023.2283109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Several studies investigated preoperative clinical features of patients with basic-acquired nonaccommodative esotropia (BANAET); however, their sample sizes were small, and they did not compare the clinical features among cases that needed different surgery times. The main purpose of this study is to compare the preoperative clinical features of patients with BANAET managed with one surgery with patients who underwent two or more strabismus surgery over 10 years. METHODS This historical cohort study was performed on the hospital records of 13,252 Iranian strabismic patients who underwent surgery at Farabi eye hospital, Tehran, Iran, from 2012 to September 2022. Of those, 2102 cases with BANAET were selected as the sample size. Data collected included sex, age at the time of first surgery, corrected distance visual acuity (CDVA), refractive error, presence of amblyopia, angle of deviation, and times of surgery. RESULTS The mean age was 18.9 ± 15.6 [1200 (57.1%) males and 902 (42.9%) females] and the median age was 14 years. In 1599 (76.1%) patients, esotropia was managed with one surgery; however, 342 (16.3%) cases were managed with two surgeries and 161 (7.6%) patients underwent three or more surgeries. The mean angle of horizontal deviation at distance and near in patients managed with two and ≥3 surgeries was significantly higher than in cases managed with one surgery (P < .001). Amblyopia was observed in 289 (18.1%) patients who were managed with one surgery, 69 (20.2%) patients with two surgeries and 43 (26.7%) patients with three or more surgeries (P < .001). Patients with BANAET managed successfully with only one surgery were younger, had better CDVA, lower astigmatism and less horizontal angle of deviation at distance and near than those who underwent two or more surgeries (all P < .001). DISCUSSION The higher astigmatism, lower CDVA, greater angle of horizontal deviation, and higher frequency of amblyopia were found in the preoperative examinations of BANAET patients managed with two or more surgeries compared with cases managed with only one surgery.
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Affiliation(s)
- Mohamad Reza Akbari
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran
| | - Alaa Alghurab
- Optometry Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran
| | - Elham Azizi
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne
| | - Masoud Khorrami-Nejad
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran
- Optometry Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran
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Nishikawa N, Kawaguchi Y, Fushitsu R. Prism adaptation response and surgical outcomes of acquired nonaccommodative comitant esotropia. Strabismus 2022; 31:9-16. [PMID: 36404773 DOI: 10.1080/09273972.2022.2143824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate the clinical factors influencing the prism adaptation response of acquired non-accommodative comitant esotropia (ANAET) and evaluate the surgical outcomes. STUDY DESIGN Retrospective observational study. METHODS This study assessed patients with ANAET who underwent strabismus surgery based on the results of a short prism adaptation test (PAT). Patients wore Fresnel trial prisms based on alternate prism cover tests in outpatient clinics. The cover test was then performed after 15-20 minutes; if the deviation increased, the power of the prism was increased to neutralize the angle. The test was repeated until the angle was stable. Patients were classified as either prism builders (angle increased by ≥ 10 prism diopters [PD] compared with the entry angle) or prism non-builders (angle increased by < 10 PD). The following clinical characteristics were noted: age at onset, age at surgery, duration of esotropia, refractive error, angle of deviation, presence or absence of intermittent esotropia at near, and pre- and postoperative sensory status. RESULTS A total of 41 patients (median age, 15.4 years) were evaluated. The mean (standard deviation) spherical equivalent refractions were -3.03 (3.33) diopters (D) and -3.05 (3.23) D in the right and left eyes, respectively. Twenty-seven (66%) patients were prism builders. The prism builders had greater myopia (builders vs. non- builders, right eye: -3.97 [2.97] vs. -1.22 [3.33] D, P = .01; left eye: -4.08 [2.78] vs. -1.07 [3.20] D; P = .003), lower angle of deviation at near (median [interquartile range] 30.0 [20.0, 35.0] vs. 42.5 [35.0, 49.4] PD; P = .009), much more preoperative intermittent esotropia or esophoria at near (44% vs. 7%, P = .03) and diplopia (96% vs. 64%, P = .01), and better postoperative stereoacuity (50 [40, 110] vs. 100 [60, 400] arcsec, P = .02) than the prism non-builders. The overall success rate was 83%, without a significant difference between the two groups (builders vs. non-builders, 89% vs. 71%, P = .21). CONCLUSION In cases of myopic refractive error, a small entry angle with intermittency at near, and good binocularity, it is recommended that surgery is performed based on prism-adapted angle to prevent under-correction.
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Affiliation(s)
- Noriko Nishikawa
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa
| | - Yuriya Kawaguchi
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa
| | - Rui Fushitsu
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa
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Sheth J, Goyal A, Natarajan D, Warkad VU, Sachdeva V, Kekunnaya R. Clinical Profile, Neuroimaging Characteristics, and Surgical Outcomes of Patients With Acute Acquired Non-accommodative Comitant Esotropia. J Pediatr Ophthalmol Strabismus 2022; 60:218-225. [PMID: 35938637 DOI: 10.3928/01913913-20220630-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the clinical presentations, neuroimaging findings, and surgical outcomes in patients with acute acquired non-accommodative comitant esotropia (AACE). METHODS A retrospective review of records of all patients diagnosed as having AACE between January 2011 and December 2019 across three tertiary eye care centers was done. Cases with AACE onset after age 1 year were included. Patients were divided into two groups based on age of onset of esotropia: childhood (16 years or younger) and adult (older than 16 years). Surgical success was defined as postoperative horizontal deviation of 8 prism diopters (PD) or less at the last follow-up visit. RESULTS A total of 338 patients (220 males and 119 females; mean age at presentation: 12.60 ± 9.8 years) met the study criteria. The mean age at onset of esotropia in the childhood and adult onset groups was 3.61 ± 1.1 and 26.6 ± 8.7 years, respectively. There were significantly more individuals with myopia (30%) in the adult onset group compared to the childhood onset group (6%) (P = .004). Thirty-seven (16%) had positive neuroimaging findings (16.4% adult onset vs 9.4% childhood onset). A total of 148 (44%) patients underwent surgery for esotropia, and the overall success rate was 73%. Mean preoperative esotropia was comparable in either group (P = .20), but surgical success was better in the adult onset group (75.6% vs 66.3% in the childhood onset group). Mean duration of follow-up postoperatively was 13.6 ± 12 months. CONCLUSIONS Two-thirds of the patients had childhood onset of AACE. Intracranial pathology was found in 1 of 6 patients. Surgical success was better in the adult onset group, which was not influenced by preoperative esotropia, neuroimaging findings, or refractive status, but was dependent on age at onset of esotropia and duration between onset and intervention. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].
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Chong C, Allen N, Jarvis R, Dai S. Ten-year review of neuroimaging in acute paediatric strabismus. Clin Exp Ophthalmol 2021; 49:724-728. [PMID: 34124827 DOI: 10.1111/ceo.13960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/27/2021] [Accepted: 06/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute childhood strabismus is often a clinical conundrum faced by ophthalmologists. Currently, there are no clear clinical guidelines on how to investigate a child presenting with acute strabismus. Furthermore, there is no consensus as to whether to initially perform neuroimaging of a child to rule out the small but serious risk of intracranial pathology, or to pursue a careful observational approach. This paper aims to outline a standardised approach to investigating acute strabismus in paediatric patients. METHODS A retrospective chart review of all paediatric patients that presented over a 10-year period to the ophthalmology departments at two tertiary level hospitals in New Zealand was conducted. Patients under 18 years of age with an acute presentation of strabismus, who underwent neuroimaging, were included. RESULTS A total of 500 patient records were reviewed. Seventy patients met the study inclusion criteria. Of these patients, 17 (24.3%) had non-isolated strabismus while 53 patients (75.7%) had isolated strabismus. Twelve patients (70.6%) who presented with a non-isolated strabismus had abnormal neuroimaging. Of those who presented with an isolated strabismus, 4 (7.5%) had abnormal neuroimaging. CONCLUSIONS Acute onset non-isolated strabismus is a significant predictor of underlying neurological abnormality in children and requires urgent neuroimaging. However, a cautious approach in which there is close observation, along with general paediatric and/or paediatric neurology input, may be appropriate for children presenting acutely with an isolated strabismus.
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Affiliation(s)
- Cheefoong Chong
- Ophthalmology Department, Waikato District Health Board, Waikato, New Zealand.,Ophthalmology Department, Auckland District Health Board, Auckland, New Zealand.,Ophthalmology Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Natalie Allen
- Ophthalmology Department, Waikato District Health Board, Waikato, New Zealand.,Ophthalmology Department, Auckland District Health Board, Auckland, New Zealand.,Ophthalmology Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Rebecca Jarvis
- Ophthalmology Department, Waikato District Health Board, Waikato, New Zealand.,Ophthalmology Department, Auckland District Health Board, Auckland, New Zealand.,Ophthalmology Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Shuan Dai
- Ophthalmology Department, Waikato District Health Board, Waikato, New Zealand.,Ophthalmology Department, Auckland District Health Board, Auckland, New Zealand.,Ophthalmology Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Geiger HG, Simonsz-Toth B, Gerth-Kahlert C. [Acute Acquired Comitant Esotropia Type 2 - A Retrospective Analysis]. Klin Monbl Augenheilkd 2021; 238:504-509. [PMID: 33930926 DOI: 10.1055/a-1384-1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Acute acquired comitant esotropia (AACE) is an uncommon form of strabismus. The main characteristics of AACE Type 2 in childhood are: acute onset of strabismus around 3 years of age, large and comitant angle of strabismus, absence of accommodative component, hyperopia of not more than 3 dpt, and measurable stereopsis. Strabismus surgery is urgently indicated in AACE Type 2 in order to avoid maldevelopment or loss of stereopsis. Therefore, in order to better describe the characteristics of AACE Type 2, we performed a retrospective analysis of patients previously seen in our clinic. PATIENTS AND METHODS Retrospective analysis of data from patients who underwent strabismus surgery between October 2011 and September 2019 due to suspected AACE Type 2 could be confirmed during postoperative visits by evaluating ocular alignment and stereopsis at our hospital. Analysed data included: age and symptoms at first visit, visual acuity, refractive status, correction by glasses, age at surgery, period of time between first symptoms and surgery, surgical procedure, stereopsis and angle of strabismus (before surgery and 1 day, 3 months, and 12 months after surgery). Ethical approval was obtained from the Cantonal Ethics Committee of Zurich. RESULTS 18 patients (12 male, 6 female) with mean hyperopia of 1.4 ± 0.6 dpt were identified as meeting the inclusion criteria during the defined time period. Amblyopia was present at first assessment in two patients. Strabismus surgery was performed at 2.0 to 11.1 years of age and between 0.4 and 24.6 months after onset of symptoms. Surgery was performed within 6 months after onset of symptoms in 12/18 children. Before surgery, angle of strabismus at near was measured as 38 ± 10 prism diopters (PD) and was reduced after surgery to 3 ± 3 PD at 3 months and 2 ± 2 PD at 12 months. Stereopsis was confirmed in 5/18 patients one day after surgery and in 18/18 patients 12 months after surgery. CONCLUSION Our analysis showed that our patients with diagnosis of AACE Type 2 had mild hyperopia and large comitant non-accommodative esotropia; prognosis for recovery of stereopsis is excellent. Preoperative amblyopia does not exclude the diagnosis of AACE Type 2. Therapeutic intervention is advisable within a short period of time after first symptoms and the diagnosis of AACE Type 2.
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Abstract
BACKGROUND Accommodative esotropia is the most common form of childhood strabismus presenting to optometric practice. Functional and cosmetic outcomes are often excellent but depend on accurate diagnosis, urgent and correct initial management and careful follow-up. CASE REPORTS We present several cases that highlight important aspects of the clinical care of accommodative esotropia. The first patient was mismanaged by undercorrection of hypermetropia, but was later accurately diagnosed to have accommodative esotropia and was subsequently managed successfully with full hypermetropic correction alone. The second patient had an accommodative esotropia with amblyopia. The third patient used a near addition to correct a residual near esotropia. CONCLUSIONS The published evidence and these cases make several points regarding assessment, diagnosis and management of esotropia. Assessment must aim to reach a diagnosis based on aetiology, as the aetiology of esotropia has a significant impact on management decisions and prognosis.
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Affiliation(s)
- Steffanie L-H Liang
- Victorian College of Optometry, The University of Melbourne, Carlton, Australia
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Gama R, Santos JC, Nom TY, Costa DCD. Differences of a Single Injection of Botulinum Toxin A between Infantile and Nonaccommodative Esotropia. J Binocul Vis Ocul Motil 2020; 70:98-102. [PMID: 32511074 DOI: 10.1080/2576117x.2020.1777063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSES To compare the results of a single injection of botulinum toxin A (BTA) between children with infantile esotropia (IET) and nonaccommodative esotropia (NAET) during the first 2 years. METHODS Retrospective study that included 23 children with IET and 25 with NAET. At 6 months, 1 and 2 years after treatment, the deviation and stereoacuity were evaluated. RESULTS At 6 months and 1 year after treatment there was no difference in ocular alignment between the two groups (success criteria were achieved in 36.8% in IET group and 60.0% in NAET at 6 months p = .129, and 57.9% in IET group and 68.0% in NAET group at 1 year p = .352). Two years after treatment, there were statistical differences between motor alignment (IET group 21,1% and NAET group 60.0%, p = .007) and stereoacuity (IET group 40% and NAET group 90%, p = .004) between the two groups. Although side-effects affected most children during the first week (in the first week, overcorrection was present in 16 (84.2%) children with IET, and in 19 (76.0%) children with NAET; and ptosis affected 15 (78.9%) children with IET and 17 (68.0%) children with NAET), at 6 months all the effects have disappeared on both groups. CONCLUSIONS We recommend BTA as an alternative, but not as definite treatment in IET if the surgeon/parents are not comfortable with an early strabismus surgery; but retreatment or surgery will have to be considered after 1 year. On the contrary, BTA may be a first-line treatment of NAET because it is an easy, safe and has a long-lasting effect.
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Affiliation(s)
- Rita Gama
- Hospital da Luz and Gama Eye Care , Lisbon, Portugal
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Schörkhuber M, Ivastinovic D, Glatz W, Schneider MR, Lindner S, Langmann A. Acute concomitant esotropia in children. Acta Ophthalmol 2018; 96:e405-e406. [PMID: 28574208 DOI: 10.1111/aos.13490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Wilfried Glatz
- Department of Ophthalmology; Medical University Graz; Graz Austria
| | | | - Susanne Lindner
- Department of Ophthalmology; Medical University Graz; Graz Austria
| | - Andrea Langmann
- Department of Ophthalmology; Medical University Graz; Graz Austria
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Li B, Sharan S. Evaluation and surgical outcome of acquired nonaccommodative esotropia among older children. Can J Ophthalmol 2018; 53:45-48. [DOI: 10.1016/j.jcjo.2017.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/07/2017] [Accepted: 07/20/2017] [Indexed: 10/18/2022]
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Schöffler C, Sturm V. Repeated Surgery for Acute Acquired Esotropia: Is It Worth the Effort? Eur J Ophthalmol 2018; 20:493-7. [DOI: 10.1177/112067211002000301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Corinna Schöffler
- Department of Ophthalmology, University Hospital of Hamburg, Hamburg - Germany
| | - Veit Sturm
- Department of Ophthalmology, University Hospital of Hamburg, Hamburg - Germany
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario - Canada
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Kim E, Choi DG. Outcomes after the surgery for acquired nonaccommodative esotropia. BMC Ophthalmol 2017; 17:130. [PMID: 28738831 PMCID: PMC5525222 DOI: 10.1186/s12886-017-0527-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 07/18/2017] [Indexed: 12/02/2022] Open
Abstract
Background To analyze the surgical outcomes for patients diagnosed with acquired nonaccommodative esotropia (ANAET). Methods In this retrospective study, the medical records of 35 patients who had undergone the surgery for ANAET with a postoperative follow-up period of 6 months or more were reviewed. The main outcome measures were postoperative esodeviation angle, final success rate, and factors affecting surgical outcome. Surgical success was considered to be an alignment within 8 prism diopters (PD) at distance and near. Results The preoperative mean esodeviation angles were 37.3 ± 13.7 PD at distance and 38.6 ± 16.6 PD at near. The postoperative mean esodeviation angles at distance were as follows: 4.2 PD at day 1, 4.0 PD at month 1, 3.9 PD at month 3, 4.9 PD at month 6, 4.7 PD at year 1, and 4.8 PD at final follow-up. There was no statistically significant difference in angle of esodeviation between the initial postoperative period (day 1 to month 6) and the final follow-up day (p > 0.05). The surgical success rate at final follow-up was 65.7% (23/35). Among the 12 patients for whom the surgery failed, 9 (24.3%) showed esotropia and 3 (8.1%) exotropia of more than 8 PD. Six patients (16.2%) underwent reoperation (4 for esotropia and 2 for exotropia). There was no factor influencing surgical outcome (p > 0.05). Conclusions The surgical outcome in patients with ANAET was relatively favorable: the final success rate was 65.7% and the reoperation rate was 17.1%.
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Affiliation(s)
- Eunbi Kim
- Department of Ophthalmology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Shingil-ro 1, Youngdeungpo-gu, Seoul, 07441, South Korea
| | - Dong Gyu Choi
- Department of Ophthalmology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Shingil-ro 1, Youngdeungpo-gu, Seoul, 07441, South Korea.
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Chen J, Deng D, Sun Y, Shen T, Cao G, Yan J, Chen Q, Ye X. Acute Acquired Concomitant Esotropia: Clinical features, Classification, and Etiology. Medicine (Baltimore) 2015; 94:e2273. [PMID: 26705210 PMCID: PMC4697976 DOI: 10.1097/md.0000000000002273] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Acute acquired concomitant esotropia (AACE) is a rare, distinct subtype of esotropia. The purpose of this retrospective study was to describe the clinical characteristics and discuss the classification and etiology of AACE.Charts from 47 patients with AACE referred to our institute between October 2010 and November 2014 were reviewed. All participants underwent a complete medical history, ophthalmologic and orthoptic examinations, and brain and orbital imaging.Mean age at onset was 26.6 ± 12.2 years. Of the 18 cases with deviations ≤ 20 PD, 16 presented with diplopia at distance and fusion at near vision at the onset of deviation; differences between distance and near deviations were < 8 PD; all cases except one were treated with prism and diplopia resolved. Of the 29 cases with deviations > 20 PD, 5 were mild hypermetropic with age at onset between 5 and 19 years, 16 were myopic, and 8 were emmetropic with age at onset > 12 years; 24 were surgically treated and 5 cases remained under observation; all 24 cases achieved normal retinal correspondence or fusion or stereopsis on postoperative day 1 in synoptophore; in 23 cases diplopia or visual confusion resolved postoperatively. Of the 47 cases, brain and orbital imaging in 2 cases revealed a tumor in the cerebellopontine angle and 1 case involved spinocerebellar ataxia as revealed by genetic testing.AACE in this study was characterized by a sudden onset of concomitant nonaccommodative esotropia with diplopia or visual confusion at 5 years of age or older and the potential for normal binocular vision. We suggest that AACE can be divided into 2 subgroups consisting of patients with relatively small versus large angle deviations. Coexisting or underlying neurological diseases were infrequent in AACE.
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Affiliation(s)
- Jingchang Chen
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, People's Republic of China (JC, DD, YS, TS, JY, QC, XY); and Department of Neurosurgery, the Second Affiliated Hospital of Guangzhou Medical University, People's Republic of China (GC)
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Buch H, Vinding T. Acute acquired comitant esotropia of childhood: a classification based on 48 children. Acta Ophthalmol 2015; 93:568-74. [PMID: 25989866 DOI: 10.1111/aos.12730] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 03/01/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE To identify characteristics of pediatric patients who develop acute acquired comitant esotropia (AACE) with and without intracranial disease. METHODS We reviewed the charts of 48 children consecutively referred to the hospital with AACE during a 13-year period. Inclusion criteria were acute onset of comitant esotropia, available data on ophthalmologic, orthoptic and neurologic examinations. Children with neurological signs, AACE recurrence or hyperopia <+3 dioptres (D) underwent brain computed tomography or magnetic resonance imaging. Patients without imaging were followed. RESULTS In all, 48 cases were recorded. The mean age at onset was 4.7 years, being significantly higher among children with intracranial disease. Seven cause-specific types of AACE in childhood were identified: The acute accommodative (n = 15, 31%), decompensated monofixation syndrome or esophoria (n = 13, 27%), idiopathic (n = 9, 19%), intracranial disease (n = 3, 6%), occlusion related (n = 3, 6%), AACE secondary to different aetiologic disease (n = 3, 6%) and cyclic AACE (n = 2, 4%). Intracranial disease included hydrocephalus, pontine and thalamic glioma. Of the children with intracranial disease, 2 of 3 had no obvious neurological signs at onset. Four significant risk factors for intracranial disease were identified as follows: larger esodeviation at distance, recurrence of AACE, neuro signs (papilledema) and older age at onset (>6 years). CONCLUSION In a large case series of children with AACE and by review of literature, we identified seven cause-specific types of AACE. Intracranial disease was present in 6%, and four risk factors were identified to guide clinicians when to perform brain imaging. Findings suggest AACE of childhood to be differentiated from AACE of adulthood.
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Affiliation(s)
- Helena Buch
- Eye & Strabismus Clinic; Copenhagen Private Hospital; Copenhagen Denmark
- Eye Clinic; Rigshospitalet Copenhagen Denmark
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Abstract
PURPOSE Esotropia, especially accommodative estropia (AE), is often seen in patients with hyperopia. In this paper, the authors aim to report the management methods of different types of esotropia in children with hypermetropia and to show the feasibility and efficacy of prismatic correction in the management of small angle of residual esotropia in accommodative estropia. METHODS A total of 82 esotropes with hyperopia treated during a 2-year period from 2007 to 2009 were reviewed retrospectively. Data were collected from the medical records. RESULTS A total of 25 patients showed pure accommodative esotropes, whereas 45 had partial AE and 12 non-AE. All 25 pure AE patients were corrected fully using glasses alone, and all 12 non-AE patients received surgery. Among the 45 partial AE cases, 35 patients with residual esodeviation of ≤30 PD received prismatic correction, with a success rate of 71.4% (25 of the 35 patients). The remaining 10 children who were not successfully treated with prismatic correction and the other 10 partial AE with residual esodeviation of >30 PD received surgery. The most recent follow-up examination indicated that all the non-surgical children were orthotropia or esophoria or had residual esotropia ≤10 PD. Among the surgical patients, 5 patients (5 in 32 or 15.6%) exhibited unstable alignment during the postoperative follow-up period, and 10 patients (10 in 32 or 31.25%) underwent additional surgery for residual esotropia. CONCLUSIONS Treatment of estropia in children with hyperopia includes wearing glasses, glasses combined with prism glasses and surgery. Prismatic correction in the treatment of small angle of residual esotropia in partial AE was feasible and efficacious. Since the follow-up lasted only a year, a long-term follow-up is needed in future studies to investigate the efficiency of the treatments.
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Affiliation(s)
- Yun-Chun Zou
- Department of Ophthalmology, West China School of Clinical Medicine, Sichuan University, China
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Abrams MS, Duncan CL, McMurtrey R. Development of motor fusion in patients with a history of strabismic amblyopia who are treated part-time with Bangerter foils. J AAPOS 2011; 15:127-30. [PMID: 21470883 DOI: 10.1016/j.jaapos.2010.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 12/04/2010] [Accepted: 12/30/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE To document the development of motor fusion when patients with a history of strabismic amblyopia are treated part-time with Bangerter foils. METHODS This was a prospective interventional outcome study of consecutive patients with a history of strabismic amblyopia, horizontal strabismus (only) ≤20(∆), visual acuity of 20/60 or better in the nonfixating eye, and no motor fusion (as indicated by the absence of prism vergence) for 1 year before entry into the study. Subjects wore a 0.1 density Bangerter foil for 3-4 hours daily. Data on visual acuity, alignment, and motor fusion status were collected for a minimum of 2 years. Patients with motor fusion were then followed for a minimum of 18 months to assess the stability of their motor fusion status after the Bangerter foil was discontinued. RESULTS Of the 46 patients meeting entry criteria (mean age, 5.3 ± 1.7 years) who completed follow-up, 28 (61%) developed motor fusion. Motor fusion was retained in all 17 patients who were followed after their foils were discontinued for a mean of 13.3 months. CONCLUSION A child's motor fusion status is generally believed to be established during an early formative period of visual development. The development of motor fusion in many of our patients during the course of part-time Bangerter foil treatment suggests that improvements in motor fusion status can occur at a later age than previously believed.
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Jacobs SM, Green-Simms A, Diehl NN, Mohney BG. Long-term follow-up of acquired nonaccommodative esotropia in a population-based cohort. Ophthalmology 2011; 118:1170-4. [PMID: 21276614 DOI: 10.1016/j.ophtha.2010.10.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 09/22/2010] [Accepted: 10/20/2010] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To describe the clinical characteristics and long-term outcomes of children diagnosed over a 30-year period with acquired nonaccommodative esotropia (ANAET). DESIGN Retrospective chart review of a population-based cohort. PARTICIPANTS All pediatric (<19 years of age) residents of Olmsted County, Minnesota, who were diagnosed with ANAET from January 1, 1965, to December 31, 1994. METHODS The medical records of all potential patients identified by the resources of the Rochester Epidemiology Project were reviewed. MAIN OUTCOME MEASURES Incidence, clinical characteristics, and long-term motor and sensory outcomes of children with ANAET. RESULTS A total of 174 children were diagnosed during the 30-year period, yielding an incidence of 1 in 287 live births. The median age at diagnosis for the 174 patients was 4.0 years (range, 10 months to 18.2 years), and 61% (107) were male (P = 0.009). Although 11% (8/75) of those queried were diplopic, none of the 174 was subsequently diagnosed with an intracranial lesion. During a mean follow-up of 10.9 years (range, 0 days to 37 years), 127 patients (73%) underwent strabismus surgery (mean, 1 surgery; range, 0-3 surgeries). Among the 127 patients who underwent surgery, the median final stereoacuity was 3000 seconds of arc, including 8 patients (6.3%) with ≥ 50 seconds of arc. Patients who were older (>44 months) at ANAET diagnosis (P = 0.005) and without amblyopia at their initial examination (P < 0.001) were more likely to achieve excellent final stereopsis. CONCLUSIONS In this population-based cohort, ANAET occurred in 1 in 287 children and was more prevalent among male children. Although diplopia was relatively common, none of the children were found to have an intracranial malignancy. Most patients achieved good motor and sensory outcomes, with the best results among those with a later onset of their deviation and no amblyopia. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Sarah M Jacobs
- Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Liu GT, Volpe NJ, Galetta SL. Eye movement disorders. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Aring E, Andersson S, Hård AL, Hellström A, Persson EK, Uvebrant P, Ygge J, Hellström A. Strabismus, Binocular Functions and Ocular Motility in Children with Hydrocephalus. Strabismus 2009; 15:79-88. [PMID: 17564937 DOI: 10.1080/09273970701405305] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate heterotropia, heterophoria, head posture, nystagmus, stereo acuity, ocular motility and near point of convergence (NPC) in children with hydrocephalus treated surgically before 1 year of age. In addition, the effects of being born with hydrocephalus, the effect of the etiology of hydrocephalus, number of shunt revisions and the size of the ventricles on these variables were studied. METHODS A population-based study was performed in 75 children and the results were compared with the results of an age- and sex-matched group (comp group) (n = 140). RESULTS Heterotropia 68.9% (comp group 3.6%; p < 0.001), abnormal head posture 41.3% (comp group 0; p < 0.001), nystagmus 44.0% (comp group 0; p < 0.001), stereo acuity < or =60'' 33.8% (comp group 97.1%; p < 0.001) and ocular motility defects 69.7% (comp group 0.7%; p < 0.001) were more common among children with hydrocephalus than in the comparison group. Children with overt hydrocephalus at birth had significantly more heterotropia (p = 0.0006), esotropia (p = 0.002), abnormal head posture (p = 0.02) and motility defects (p = 0.003) compared to those with hydrocephalus developing during the first year of life. The etiology, number of shunt revisions and the size of the ventricles had no significant effect on any of the investigated variables. CONCLUSIONS Children with hydrocephalus surgically treated before the age of one year commonly present orthoptic abnormalities. The etiology of hydrocephalus, number of shunt revisions and ventricle size seem to be of minor importance compared with the age of onset of hydrocephalus with regard to the risk for orthoptic abnormalities.
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Affiliation(s)
- Eva Aring
- Department of Ophthalmology, Institute of Clinical Neuroscience, The Sahlgrenska Academy of Göteborg University, Göteborg, Sweden.
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Abstract
AIM Recent studies suggest that Asian strabismus patterns are different from those in the West. This study aims to determine the profile of children with comitant horizontal strabismus in Singapore. METHOD 682 children aged <or=16 years presenting with strabismus for the first time between 2000 and 2002 were included in this study. The type and size of the squint, visual acuity, refractive error and stereopsis were noted. RESULTS 493 children (72%) were exotropic, the majority (92%) of whom had intermittent exotropia, X(T). The divergence excess type X(T) was most common (59.5%), followed by basic (29.0%) and convergence-weakness (11.5%). Children with X(T) demonstrated stereopsis for near in 92% and distance in 50%. Esotropia was present in 191 (28%) children (23% infantile and 53% accommodative). Children with infantile esotropia presented significantly younger (2.8 years vs 4.5 years), had larger squint size (35D vs 26D) and were less hyperopic (+0.78D vs +2.79D). Amblyopia or ocular preference was noted in 50% of children with infantile esotropia, and 43% with accommodative esotropia. CONCLUSION Twice as many Singaporean children presented with exotropia than esotropia. However, within the exotropia and esotropia groups, the distribution and characteristics of various strabismus subtypes bore similar characteristics to those described in the West.
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Affiliation(s)
- Audrey Chia
- FRANZCO, Singapore National Eye Center, 11 Third Hospital Avenue, Singapore.
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Kitzmann AS, Mohney BG, Diehl NN. Progressive increase in the angle of deviation in acquired nonaccommodative esotropia of childhood. J AAPOS 2003; 7:349-53. [PMID: 14566318 DOI: 10.1016/s1091-8531(03)00216-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Although the angle of deviation in patients with congenital esotropia has been shown to increase during the early preoperative period, few data exist regarding this change in other forms of childhood esotropia. The primary objective of this study was to investigate whether the angle of deviation increases with time in patients with acquired nonaccommodative esotropia (ANAET). METHODS The medical records of all children whose ANAET was diagnosed at East Tennessee State University College of Medicine from August 1, 1995, through October 1, 2001, were retrospectively reviewed. All patients were assessed for any change in the amount of their strabismic angle and associated risk factors. RESULTS Eighty-two patients with ANAET were identified, and all except 3 underwent more than one examination. Of the 79 children who underwent more than one examination, 26 (32.9%) displayed an angle increase of > or =10 prism diopters (PD) during a median follow-up period of 2.9 months. The ANAET of those patients whose angle increased by > or =10 PD was diagnosed (28.4 months of age vs 45.5 months of age, P =.003), and they underwent surgery (35.9 months of age vs 53.3 months of age, P =.003) at a significantly younger median age than those whose angle increased <10 PD. CONCLUSIONS The angle of deviation of approximately one third of patients with ANAET in this study increased at least 10 PD in the early preoperative period. This increase occurs more often in younger patients and underscores the importance of performing serial measurements of the deviating angle before surgical intervention is undertaken.
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Affiliation(s)
- Anna S Kitzmann
- Department of Ophthalmology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
PURPOSE To identify the characteristics of adult patients who develop acute concomitant esotropia of adulthood. DESIGN Retrospective noncomparative case series. PARTICIPANTS Ten patients were included in this study. INTERVENTION The charts of all adults with acute-onset concomitant esotropia who were examined at our institute between 1990 and 1997 were reviewed, and those who had developed the syndrome when they were older than the age of 16 years were included in this study. All participants underwent a complete ocular and physical examination, including brain and orbital computed tomography. MAIN OUTCOME MEASURES Angle of esotropia, measured by the prism and cover test. RESULTS The mean age +/- standard deviation at the time of the ocular and physical examination was 38 +/- 18.6 years (range, 18-70 years). The mean myopic error was -4.1 +/- 3.2 diopters (range, +2.0 to -8.5 diopters). Nine of the 10 patients were myopic. The mean angle of esotropia was 33.8 +/- 14.7 prism diopters (range, 18-60 prism diopters). The mean period of follow-up was 2.2 +/- 1.0 years (range, 1-4 years). After surgery, all patients were orthophoric or minimally esophoric, and in all of them, stereoacuity (measured by the Titmus stereofly test) was 40 arc seconds. CONCLUSIONS In a well-defined group of adult patients with acute-onset concomitant esotropia, almost all were myopic, and all regained normal stereopsis after surgery. Acute concomitant esotropia of adulthood should probably be classified as a distinct subgroup of acute-onset esotropia.
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Affiliation(s)
- Abraham Spierer
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.
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