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Nouraeinejad A. Neurological pathologies in acute acquired comitant esotropia. Graefes Arch Clin Exp Ophthalmol 2023; 261:3347-3354. [PMID: 37145335 PMCID: PMC10161163 DOI: 10.1007/s00417-023-06092-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/16/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Acute acquired comitant esotropia (AACE) is an uncommon subtype of esotropia characterized by sudden and usually late onset of a relatively large angle of comitant esotropia with diplopia in older children and adults. METHODS A literature survey regarding neurological pathologies in AACE was conducted using databases (PubMed, MEDLINE, EMBASE, BioMed Central, the Cochrane Library, and Web of Science) in order to collect data for a narrative review of published reports and available literature. RESULTS The results of the literature survey were analyzed to provide an overview of the current knowledge of neurological pathologies in AACE. The results revealed that AACE with unclear etiologies can occur in many cases in both children and adults. Functional etiological factors for AACE were found to be due to many reasons, such as functional accommodative spasm, the excessive near work use of mobile phones/smartphones, and other digital screens. In addition, AACE was found to be associated with neurological disorders, such as astrocytoma of the corpus callosum, medulloblastoma, tumors of the brain stem or cerebellum, Arnold-Chiari malformation, cerebellar astrocytoma, Chiari 1 malformation, idiopathic intracranial hypertension, pontine glioma, cerebellar ataxia, thalamic lesions, myasthenia gravis, certain types of seizures, and hydrocephalus. CONCLUSIONS Previously reported cases of AACE with unknown etiologies have been reported in both children and adults. However, AACE can be associated with neurological disorders that require neuroimaging probes. The author recommends that clinicians should perform comprehensive neurological assessments to rule out neurological pathologies in AACE, especially in the presence of nystagmus or abnormal ocular and neurological indications (e.g., headache, cerebellar imbalance, weakness, nystagmus, papilloedema, clumsiness, and poor motor coordination).
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Affiliation(s)
- Ali Nouraeinejad
- Department of Clinical Ophthalmology, University College London (UCL), London, United Kingdom.
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Okita Y, Kimura A, Masuda A, Mochizuki Y, Kondo M, Yamadera K, Gomi F. Yearly changes in cases of acute acquired comitant esotropia during a 12-year period. Graefes Arch Clin Exp Ophthalmol 2023; 261:2661-2668. [PMID: 37067584 PMCID: PMC10107582 DOI: 10.1007/s00417-023-06047-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/06/2023] [Accepted: 03/24/2023] [Indexed: 04/18/2023] Open
Abstract
PURPOSE The number of patients with acute acquired comitant esotropia (AACE) has been increasing in Japan. The purpose of this study was to investigate the changes in the number and characteristics of patients with AACE examined in our institution during a 12-year period. METHODS We retrospectively reviewed the medical records of patients with AACE aged < 30 years who suddenly developed diplopia or esotropia and were examined in Hyogo College of Medicine Hospital from January 2008 to December 2021. We investigated the association of the yearly changes in the number of patients with the age category, refractive error category, AACE type, esotropia type, and use or nonuse of smartphones. RESULTS The total number of patients with AACE was 171, and this number significantly increased each year (Pearson correlation coefficient, 0.9450; p < 0.0001). Significant increases were found among students in junior high school and beyond, patients with myopia, patients with Bielschowsky type AACE, and patients with basic esotropia (p < 0.0001 for all). We compared two age groups, elementary school students and below versus junior high school students and above, and found that the rate of increase was significantly higher in the junior high school students and above (estimate, 1.951; p < 0.0001), and the non-myopia group and myopia group and found that the rate of increase was significantly higher in the myopia group (estimate, 1.891; p < 0.0001). Excessive use of smartphones was confirmed in 82 of 133 patients, and the rate of the increase in the number of patients with AACE was significantly greater among patients with than without excessive use of smartphones (estimate, 1.098; p = 0.0009). CONCLUSION This study confirmed a significant increase in the number of patients with AACE in recent years. The excessive use of smartphones may be associated with the increase in AACE.
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Affiliation(s)
- Yoichi Okita
- Department of Ophthalmology, Hyogo Medical University, 1-1, Mukogawa-Choho, Nishinomiya-Cityity, Hyogo, Japan
| | - Akiko Kimura
- Department of Ophthalmology, Hyogo Medical University, 1-1, Mukogawa-Choho, Nishinomiya-Cityity, Hyogo, Japan.
| | - Akiko Masuda
- Department of Ophthalmology, Hyogo Medical University, 1-1, Mukogawa-Choho, Nishinomiya-Cityity, Hyogo, Japan
| | - Yoshihito Mochizuki
- Department of Ophthalmology, Hyogo Medical University, 1-1, Mukogawa-Choho, Nishinomiya-Cityity, Hyogo, Japan
| | - Miho Kondo
- Department of Ophthalmology, Hyogo Medical University, 1-1, Mukogawa-Choho, Nishinomiya-Cityity, Hyogo, Japan
| | - Katsuhide Yamadera
- Department of Ophthalmology, Hyogo Medical University, 1-1, Mukogawa-Choho, Nishinomiya-Cityity, Hyogo, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo Medical University, 1-1, Mukogawa-Choho, Nishinomiya-Cityity, Hyogo, Japan
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Nouraeinejad A. To prioritize treatment options for acute acquired comitant esotropia. Eur J Ophthalmol 2023:11206721231165450. [PMID: 36935635 DOI: 10.1177/11206721231165450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
The management of acute acquired comitant esotropia (AACE) is controversial, and no clear guidelines exist to guide its treatment options. Therefore, the author proposes his idea that treatment options for AACE should be prioritized to achieve optimal outcomes with fewer potential complications for this type of esotropia. In this manner, treatment should be started with less invasive, muscle-sparing procedures while the patient is regularly checked for improvement in esotropia and diplopia. This is also a good scheme because the patient can go through vital neurological and ophthalmological assessments while he/she is spared from invasive interventions in the beginning.
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Affiliation(s)
- Ali Nouraeinejad
- Department of Clinical Ophthalmology, 4919University College London, London, UK
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Nouraeinejad A. Neurological pathologies associated with acute acquired comitant esotropia. Int J Neurosci 2023:1-2. [PMID: 36751092 DOI: 10.1080/00207454.2023.2178432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/04/2023] [Indexed: 02/09/2023]
Abstract
Previously reported cases of acute acquired comitant esotropia (AACE) with unknown etiologies have been reported in both children and adults. However, AACE can be associated with neurological disorders that require neuroimaging probes. The author recommends that clinicians should perform comprehensive neurological assessments to rule out neurological pathologies in AACE, especially in the presence of A or V pattern esotropia, nystagmus, or abnormal ocular and neurological indications (e.g. headache, cerebellar imbalance, weakness, nystagmus, papilloedema, clumsiness, and poor motor coordination).
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Affiliation(s)
- Ali Nouraeinejad
- Faculty of Brain Sciences, Institute of Ophthalmology, University College London (UCL), London, UK
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Montriwet M. Possibility of Neurological Diseases Associated with Acute Acquired Comitant Esotropia. Korean J Ophthalmol 2023; 37:120-127. [PMID: 36758536 PMCID: PMC10151165 DOI: 10.3341/kjo.2022.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/15/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose This study investigated the possibility of neurological etiologies causing acute acquired comitant esotropia (AACE) and to evaluate the differences in clinical features between younger children, older children, and adults. Methods In this retrospective analysis, patients who had been diagnosed with AACE between July 2017 and June 2021 were included. Data on clinical findings, medical history, brain or orbital imaging, and ophthalmological and orthoptic examinations were retrieved from medical records and analyzed. Patients were divided into three groups based on their age: younger children (<10 years), older children (10-18 years), and adults (>18 years). Results Overall, 41 patients with AACE (15 females and 26 males) were examined. Most patients were children. Mild hyperopia was observed in children, while adults had moderate to high myopia. The mean angle of esotropia at a distance fixation was 43.57±9.77, 51.54±8.75, and 30.14±12.39 prism diopters (PD) in younger children, older children, and adult groups, respectively. The mean angle of esotropia at a near fixation was 43.57±9.37, 51.15±9.39, and 31.43±12.15 PD in younger children, older children, and adult groups, respectively. Significant differences were found in the mean angles of esotropia in patients with AACE at both near and far distances according to their age (P<0.001, P<0.001, respectively). Among 36 patients with previous neuroimaging data, none had AACE secondary to intracranial lesions. Over two years, five patients who were under continuous observation did not develop any neurological abnormalities. Conclusion AACE was more common in children than in adults. The angle of deviation was larger in children than in adults. Coexisting or underlying neurological diseases were not present in patients with isolated AACE, which eliminated the need for neuroimaging. Continuous follow-up evaluations are warranted when signs of intracranial disease are observed in patients who have not undergone an imaging investigation.
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Affiliation(s)
- Mayuree Montriwet
- Department of Ophthalmology, Faculty of Medicine, Naresuan University, Phitsanulok 6500, Thailand
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Yagasaki A, Miyase T, Sakai S, Mochizuki K, Sakaguchi H, Yagasaki T, Ohe N, Yasue S, Endo S, Ozeki M. Two Pediatric Patients with Acute Acquired Comitant Esotropia as the First Symptom of Brainstem Tumor: A Case Report. Case Rep Ophthalmol 2023; 14:613-619. [PMID: 37946847 PMCID: PMC10631780 DOI: 10.1159/000534709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023] Open
Abstract
Introduction Acute acquired comitant esotropia (AACE) is an acquired strabismus with uncrossed sudden-onset diplopia due to esodeviation, comitant esotropia without accommodation factor, or paretic eye movement. The diagnosis of AACE entails differentiation from incomitant esotropia caused by abnormalities in the central nervous system. We present 2 pediatric patients with AACE as the first symptom of brainstem tumor. Case Presentation The 2 patients were aware of their diplopia and had no other neurological abnormalities. There were no special findings in the anterior segment, ocular media, or fundus. Esotropia with a difference of no more than 10Δ between distant and near fixations was observed. Eye movements were normal, and Hess red-green test under prism neutralization did not reveal abduction restriction. The presumed cause of AACE in both patients was excessive use of digital displays, and brain magnetic resonance imaging (MRI) was performed to confirm the absence of neurological abnormality. Using MRI, a definitive diagnosis of AACE was made based on comitant esotropia associated with diffuse median glioma and medullary pilocytic astrocytoma without abducens nerve palsy. Conclusion Although the incidence of AACE caused by brainstem tumors may be low, it is necessary to perform head imaging to confirm etiology. Furthermore, Hess red-green test under prism neutralization is considered important for the differentiation of abducens nerve palsy.
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Affiliation(s)
- Ayaka Yagasaki
- Department of Ophthalmology, Gifu Prefectural General Medical Center, Gifu, Japan
- Department of Ophthalmology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Taishi Miyase
- Department of Ophthalmology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Shota Sakai
- Department of Ophthalmology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Kiyofumi Mochizuki
- Department of Ophthalmology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | | | - Naoyuki Ohe
- Department of Neurosurgery, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Shiho Yasue
- Department of Pediatrics, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Saori Endo
- Department of Pediatrics, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu Prefectural General Medical Center, Gifu, Japan
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Zhou Y, Ling L, Wang X, Jiang C, Wen W, Zhao C. Augmented-Dose Unilateral Recession-Resection Procedure in Acute Acquired Comitant Esotropia. Ophthalmology 2022:S0161-6420(22)01013-2. [PMID: 36572256 DOI: 10.1016/j.ophtha.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/28/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To compare the surgical amount of unilateral medial rectus recession and lateral rectus resection (RR) in patients with acute acquired comitant esotropia (AACE) versus common forms of esotropia and to provide dose-response reference for surgical planning in AACE. DESIGN Retrospective study. PARTICIPANTS Consecutive patients who underwent unilateral RR for AACE or common forms of esotropia correction from January 2018 to January 2022. Only patients who achieved motor and sensory success with a minimum follow-up of 3 months were analyzed. METHODS Group differences in the amount of medial rectus (MR) recession and lateral rectus (LR) resection were analyzed using multivariate regression models. Surgical dose responses in AACE were analyzed using multivariable regression models. Regression models were performed with and without adjustment for clinical confounders. Piecewise analysis was used to detect segmented results. MAIN OUTCOME MEASURES Group difference in surgical amount and dose responses of unilateral RR in AACE. RESULTS Fifty-four patients with AACE and 98 patients with common forms of esotropia were included. To correct comparable deviations, surgical amount performed was significant larger in AACE patients, with the adjusted group differences of 0.49 mm (95% confidence interval [CI], 0.34-0.65 mm; P < 0.001) in MR recession and 1.68 mm (95% CI, 1.25-2.11 mm; P < 0.001) in LR resection in patients with deviation < 40 prism diopters (Δ) and with a group difference of 1.22 mm (95% CI, 0.76-1.68 mm; P < 0.001) in LR resection in those with deviation ≥ 40 Δ. In AACE patients, in the adjusted model taking into account the intercept, dose responses of MR recession and LR resection in patients with deviation < 30 Δ were 5.11 Δ/mm (95% CI, 0.98-9.23 Δ/mm; P = 0.02) and 2.51 Δ/mm (95% CI, 0.57-4.45 Δ/mm; P = 0.02), respectively, and for those with deviation ≥ 30 Δ, the dose response of additional LR resection was 5.48 Δ/mm (95% CI, 4.56-6.40 Δ/mm; P < 0.001) to correct remaining deviation beyond 30 Δ. CONCLUSIONS These findings provide quantitative evidence that augmented-dose unilateral RR should be performed in AACE for favorable surgical outcomes. The new surgical dose calculation proposed provides reference for surgical planning. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Dai Z, Zheng F, Xu M, Zhou J, Wan M, Yu H, Hou F, Chen J, Yu X. Effect of the base-out recovery point as the surgical target for acute acquired comitant esotropia. Graefes Arch Clin Exp Ophthalmol 2021; 259:3787-3794. [PMID: 34319423 DOI: 10.1007/s00417-021-05318-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the treatment efficacy of the preoperative base-out recovery point as the surgical target angle for acute acquired comitant esotropia. METHODS Prospective study. Twenty-two patients with acute acquired comitant esotropia (AACE) underwent strabismus surgery based on the target angle of the preoperative base-out recovery point. The postoperative deviation, positive fusional vergence, and negative fusional vergence were evaluated and compared with those of 23 normal individuals. RESULTS The mean follow-up period was 18.68 ± 19.48 months. At the last follow-up, 19 (86.4%) of 22 subjects had orthophoria, whereas 3 (13.6%) had minimal esophoria. The postoperative angle of deviation was significantly smaller than the preoperative angle of deviation at near (P < 0.001) and distance (P < 0.001). Postoperative sensory fusion was significantly better than preoperative fusion at near (P < 0.001) and distance (P < 0.001). The postoperative stereoacuity improved significantly after the surgery at near (P < 0.001) and distance (P < 0.001). Compared with the controls, the convergence and divergence amplitudes in the AACE patients were similar at distance (P > 0.05) but were still narrower at near (P < 0.001). CONCLUSION Good alignment and binocular balance were obtained with the surgical target angle of the base-out recovery point in AACE.
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Affiliation(s)
- Zhiyue Dai
- The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Rd., Wenzhou, 325027, Zhejiang, China
| | - Fuhao Zheng
- The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Rd., Wenzhou, 325027, Zhejiang, China
| | - Meiping Xu
- The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Rd., Wenzhou, 325027, Zhejiang, China
| | - Jinjing Zhou
- The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Rd., Wenzhou, 325027, Zhejiang, China
| | - Minghui Wan
- The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Rd., Wenzhou, 325027, Zhejiang, China
| | - Huanyun Yu
- The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Rd., Wenzhou, 325027, Zhejiang, China
| | - Fang Hou
- The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Rd., Wenzhou, 325027, Zhejiang, China
| | - Jinmao Chen
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xinping Yu
- The Eye Hospital of Wenzhou Medical University, No. 270, West Xueyuan Rd., Wenzhou, 325027, Zhejiang, China.
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Mohan A, Sen P, Mujumdar D, Shah C, Jain E. Series of cases of acute acquired comitant esotropia in children associated with excessive online classes on smartphone during COVID-19 pandemic; digital eye strain among kids (DESK) study-3. Strabismus 2021; 29:163-167. [PMID: 34223812 DOI: 10.1080/09273972.2021.1948072] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Extra time of sitting in front of a digital device is required for e-learning by children during Corona virus (COVID-19) pandemic which can lead to many ocular problems including digital eye strain (DES). In view of increased incidence of DES in children, multiple studies had been conducted in central India to assess the eye strain in children due to excessive online classes as a research project named "Digital eye strain among kids (DESK) study." This study DESK-3 aimed to report series of cases of acute acquired comitant esotropia (AACE) in children attending online classes during COVID-19 pandemic. Children aged 6-18 years with recent onset of esotropia of < 1-month duration without any similar history in past presented in month of July-August 2020 at a tertiary children eye care hospital were evaluated. Data collection included age and gender of child, presence or absence of diplopia, visual acuity, duration of smartphone use, duration of online classes, angle of deviation for near and distance and cycloplegic refraction. Total eight children of AACE were included in the study. The mean age of children was 12.5 ± 4.2 years. All eight were males. The mean duration of smartphone use was 4.6 + 0.7 hours per day. All children were attending online classes > 4 hours per day on smartphone of average size 5.5 inches. Five children were emmetropic, one myopic, one pseudomyopic and one hyperopic. The angle of deviation for near and distance were 48.1 ± 16.4 PD and 49.3 ± 15.9 PD respectively with normal ocular motility. Seven children complained of horizontal diplopia in all gazes. Neurological examination and CT scan of brain and orbit was normal in all patients. Two months before the lockdown only one case was identified as compared to eight during the lockdown. Prolonged near work during smart phone use for e-learning might lead to the development of AACE in children.
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Affiliation(s)
- Amit Mohan
- Children Eye Care Center, Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, MP
| | - Pradhnya Sen
- Children Eye Care Center, Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, MP
| | - Deepti Mujumdar
- Children Eye Care Center, Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, MP
| | - Chintan Shah
- Children Eye Care Center, Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, MP
| | - Elesh Jain
- Children Eye Care Center, Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, MP
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Abstract
Background Acute acquired comitant esotropia (AACE) is a type of strabismus characterized by a sudden onset of large angle esotropia with diplopia, which often occurs in children after infancy, teenagers, and young adolescents. However, studies on the surgical outcomes of only adults are rare. The purpose of this article is to analyze the surgical outcomes for adult patients diagnosed with AACE. Methods Medical records of 24 patients who had undergone surgery for AACE were retrospectively analyzed. The main outcome measures were the final motor and sensory success rate after surgery and factors affecting motor and sensory outcomes. Motor success was considered alignment within 8 prism diopter (PD) at both near and distance and sensory success was stereoacuity ≥ 60 sec/arc. Results The preoperative mean esodeviation angles were 33.1 ± 10.4 PD at distance and 33.3 ± 11.2 PD at near. The mean period of postoperative follow up was 7.5 ± 4.5 months (range 1–8 months). The postoperative mean esodeviation angles at final follow-up time were 3.4 ± 6.1 PD at distance and 3.8 ± 6.7 PD at near. The surgical motor success rate at final follow-up was 79.2% (19/24). The sensory success rate at final follow-up was 50.0% (12/24). The factor affecting the motor outcome was the type of surgery (p < 0.05). The factor affecting sensory outcome was postoperative follow-up time (p < 0.05). Conclusions Surgery type appears to affect surgical motor outcomes in adults with AACE. Although the sensory outcome was favorable, it seems that regaining bifoveal fixation takes time.
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Affiliation(s)
- Dae Hyun Kim
- Department of Ophthalmology, Chosun University Hospital, 365 Pilmundaero, Dong-gu, 61453, Gwang-ju, South Korea.
| | - Ha Jeong Noh
- Department of Ophthalmology, Chosun University Hospital, 365 Pilmundaero, Dong-gu, 61453, Gwang-ju, South Korea
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Tong L, Yu X, Tang X, Zhang Y, Zheng S, Sun Z. Functional acute acquired comitant esotropia: clinical characteristics and efficacy of single Botulinum toxin type A injection. BMC Ophthalmol 2020; 20:464. [PMID: 33238930 PMCID: PMC7689961 DOI: 10.1186/s12886-020-01739-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background To examine the clinical features of acute acquired comitant esotropia (AACE) and to evaluate the clinical effectiveness of a single injection of botulinum toxin type A (BTXA) on binocular visual function (BVF). Methods This retrospective, observational case series study enrolled patients with AACE examined from October 2018–May 2019. BTXA was injected into the both medial rectus muscles. The refractive error, best-corrected visual acuity (BCVA), stereoacuity, vergence, accommodation, the horizontal angle of deviation, and the gradient accommodative convergence/accommodation (AC/A) ratio were measured pre- and post-BTXA injection. Data pre- and postinjection were compared by the Wilcoxon signed-rank test. A Spearman correlation coefficient was calculated to explore the relationships between demographic characteristics and BVF. Results Twenty-two AACE cases were included. Compared with preinjection deviation, the postinjection deviation in the primary position was smaller for near (p < 0.001) and distance (p < 0.001) fixation at 3 months after injection (BTXA). Furthermore, convergence was better for near (p = 0.003) and distance (p < 0.001) fixation, divergence was better for near (p = 0.021) and distance (p < 0.001) fixation, accommodation was better in the right (p = 0.011) and left (p = 0.004) eyes, and the gradient AC/A ratio was better at the third month after injection (p = 0.001). Stereoacuity was improved in 11 (50%), unchanged in 5 (22.73%) and decreased in 6 (27.27%) patients. The preinjection stereoacuity (p = 0.013, r = 0.522) and preinjection deviation for near (p = 0.015 r, = − 0.512) and distance (p = 0.009, r = − 0.541) were significantly associated with patient age. Conclusions AACE is characterized by a high AC/A ratio and low accommodation. A single injection of BTXA is effective for AACE. Deviation, stereoacuity, and the therapeutic effect of BTXA may be correlated with patient age.
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Affiliation(s)
- Luyao Tong
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, Zhejiang Province, China.,Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang Province, China
| | - Xiaoning Yu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, Zhejiang Province, China
| | - Xiajing Tang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, Zhejiang Province, China
| | - Yidong Zhang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, Zhejiang Province, China
| | - Sifan Zheng
- GKT School of Medical Education, King's College London, London, SE1 1UL, England
| | - Zhaohui Sun
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, Zhejiang Province, China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lee HJ, Kim SJ. Clinical characteristics and surgical outcomes of adults with acute acquired comitant esotropia. Jpn J Ophthalmol 2019; 63:483-9. [PMID: 31549267 DOI: 10.1007/s10384-019-00688-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 08/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate clinical characteristics of adults with acute acquired comitant esotropia and to evaluate the muscle recession amount needed to achieve a favorable outcome after performing medial rectus muscle recession. STUDY DESIGNS Retrospective study. METHODS Patients diagnosed with acute acquired comitant esotropia, who underwent medial rectus muscle recession with adjustable suture between 2008 and 2016 were included. Surgical outcomes were classified into motor and sensory. The motor outcomes were evaluated at the 1-year postoperative visit and divided into success (orthotropia or esodeviation ≤ 8 PD) and failure (esodeviation > 8 PD). The successful sensory outcomes were defined as elimination of diplopia in primary gaze. Factors including age, sex, refractive error, deviation angle, and surgical amount were compared between groups. RESULTS Sixteen subjects were included whose mean (± SD) age at the initial visit was 27.5 ± 11.0 years. Mean preoperative maximum angle of deviation was 27.9 ± 9.3 PD at distance and 28.6 ± 12.0 PD at near. Mean refractive error was -2.55 ± 2.92 D. Twelve of 16 subjects (75%) had successful motor and sensory outcomes. Age, sex, refractive error and deviation angle were not different between the two groups. Both success and failure groups required a greater amount of medial rectus muscle recession than those indicated by the Parks' surgical table, with a 40.6 ± 25.8 % augmentation in the success and 7.9 ± 6.9 % in the failure group (P = .028). CONCLUSIONS To achieve better surgical outcomes in adults with acute acquired comitant esotropia, targeting postoperative orthotropia by increasing the amount of medial rectus muscle recession is recommended.
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Cai C, Dai H, Shen Y. Clinical characteristics and surgical outcomes of acute acquired Comitant Esotropia. BMC Ophthalmol 2019; 19:173. [PMID: 31391009 PMCID: PMC6686525 DOI: 10.1186/s12886-019-1182-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To describe the clinical characteristics and the outcomes of strabismus surgery for acute acquired comitant esotropia (AACE). METHODS Medical records of 45 AACE patients were retrospectively analyzed. The insertion location of medial rectus was compared between the AACE patients and comitant exotropic patients. The location was also compared with those measured in other studies. Surgical outcome measurements included amount of deviation and level of binocularity at last follow-up. RESULTS The distance from medial rectus to limbus was shorter in AACE patients than in patients with comitant exotropia. The distance was also shorter in AACE patients than patients in other studies. Out of the 45 patients, 2 had neurological diseases. Neostigmine test was negative in all patients. The age at onset of AACE was 5-47 years (mean 19.1 ± 7.3 years), one patient was 5 years (2.2%), 20 patients were 11-17 years (44.5%) and the other 24 patients were 18-47 years old (53.3%). The mean cycloplegic refraction was - 4.1 ± 3.0 diopters (D) and 41 patients were myopic (91%). The angle of deviation was 40.5 ± 19.5 prism diopters (PD) at distance and 35.6 ± 19.9PD at near preoperatively. The angle was 0.8 ± 1.6 PD at distance and 0.7 ± 1.8 PD at near postoperatively. Diplopia resolved in patients who underwent strabismus surgery, with no recurrence during the follow-up period. Thirty patients had stereopsis postoperatively. CONCLUSIONS AACE seems to occur mostly in older children and adults and myopes. The distance from the insertion to limbus of medial rectus was shorter in patients with AACE. Good results can be achieved by strabismus surgery.
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Affiliation(s)
- Chunyan Cai
- Eye center, Wuhan University Renmin Hospital, Wuhan, 430060, China
| | - Hongbin Dai
- Wuhan Aier Eye Hospital, Wuhan, 430063, China
| | - Yin Shen
- Eye center, Wuhan University Renmin Hospital, Wuhan, 430060, China.
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