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Lee MYR, Lee MSP. Risk Factors for Acute Acquired Comitant Esotropia in Children and Young Adults: A Systematic Review. Br Ir Orthopt J 2024; 20:193-206. [PMID: 39246730 PMCID: PMC11378710 DOI: 10.22599/bioj.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/19/2024] [Indexed: 09/10/2024] Open
Abstract
Background Acute acquired comitant esotropia (AACE) is a rare subtype of esotropia that occurs after infancy. The exact pathogenesis of AACE remains unknown with aetiologies ranging from benign conditions to serious underlying neurological diseases being reported. Given the elusive characteristic of AACE, diagnostic and management guidelines remain unclear. This systematic review aims to contribute to this field by summarising the risk factors for AACE reported thus far. Methods A systematic review was conducted with papers found in CINAHL, MEDLINE, Cochrane library, PubMed databases and other sources. Eligible studies investigating the risk factors for, and clinical features of, AACE in children and young adults were critically appraised before relevant data were extracted and discussed via a narrative summary. Results Twelve studies were included in the final review, of which six and eight papers reported on benign and non-benign risk factors for AACE respectively. Identified benign risk factors varied among studies, while non-benign risk factors were associated with intracranial pathologies, multiple sclerosis and head trauma. Conclusion Given the low generalisability of study findings, no definitive conclusions can be drawn on the significance of each risk factor on AACE development. Further prospective research with more objective measurements of 'near work', larger sample sizes and control groups is required to better ascertain any cause-effect relationship, refine the diagnostic criteria for each AACE subtype and advise on appropriate management guidelines for AACE.
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Acar Z, Yılmaz Tuğan B. Clinical characteristics and treatment outcomes of myopic children and adolescents with acute acquired comitant esotropia. Clin Exp Optom 2024:1-5. [PMID: 39129438 DOI: 10.1080/08164622.2024.2361753] [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: 12/19/2023] [Accepted: 05/22/2024] [Indexed: 08/13/2024] Open
Abstract
CLINICAL RELEVANCE Acute acquired comitant esotropia (AACE) is becoming increasingly common in young children. Understanding clinical characteristics and treatment outcomes can inform future practice. BACKGROUND To evaluate clinical characteristics of myopic children and adolescents with AACE, and the outcomes of varying treatments. METHODS A retrospective review of medical records was conducted to identify patients diagnosed with AACE and diplopia between 2016 and 2020. The duration of smartphone use, angle of deviation, refractive error, stereopsis, and treatment options were analysed. The motor outcomes were evaluated at the earliest 6-month postoperative visit (6-30 months), and orthotropia or esodeviation ≤10 prism dioptres (PD) was defined as success. Successful sensory outcomes were defined as the elimination of diplopia in primary gaze or the presence of stereoacuity. RESULTS Twelve patients diagnosed with AACE were identified. Ages were between 9 and 19 years (15.6 ± 3.3 years). All patients showed convergent and comitant esotropia ranging from 12 to 40 PD at distance fixation that was nearly equivalent for distance and near fixation. The mean age at the initial visit was 15.6 ± 3.3 years. Post-treatment esodeviations were significantly lower at both distance and near compared to pretreatment (p < 0.001, for both). Eight patients required surgery and were treated with bilateral medial rectus muscle recession, two patients were treated with botulinum toxin, and two patients were followed with prismatic glasses. Nine of 10 patients (%90) treated with either surgery or botulinum toxin had successful motor and sensory outcomes. CONCLUSIONS Surgery is the most efficient treatment option; botulinum toxin and prismatic glasses could be useful treatment options in patients who refuse to have surgery or for whom the amount of deviation is small and variable.
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Affiliation(s)
- Zeynep Acar
- Department of Ophthalmology, Dünyagöz Eye Hospital, İstanbul, Turkey
| | - Büşra Yılmaz Tuğan
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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Mittendorf L, Bernhard MK, Sterker I, Kiess W, Gburek-Augustat J, Merkenschlager A. Still an Unsolved Question: The Place of Cranial Magnetic Resonance Imaging in Acute Acquired Concomitant Esotropia. CHILDREN (BASEL, SWITZERLAND) 2024; 11:519. [PMID: 38790514 PMCID: PMC11119212 DOI: 10.3390/children11050519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE The aim of this study was to collect further data to estimate the risk of relevant intracranial pathology and thereby better assess the need for cranial imaging in children with acute acquired comitant esotropia (AACE). To date, there is still not enough literature on this topic to enable a consensus on the diagnostic algorithm. METHODS We analyzed data from patients with convergent strabismus who received cranial imaging via magnetic resonance imaging (MRI). Twenty-one patients received a cranial MRI for the diagnostic evaluation of AACE. The age range was from 2 to 12 years, and the mean age at the time of diagnosis was 5.5 years. Of these patients, only one exhibited insignificant MRI findings, with no therapeutic consequences. CONCLUSIONS Our data add further evidence that AACE without neurological findings or other ophthalmologic anomalies might not be an indication for cranial MRI as a diagnostic screening tool.
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Affiliation(s)
- Luisa Mittendorf
- Division of Neuropediatrics, Hospital for Children and Adolescents, Department of Women and Child Health, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany; (M.K.B.); (A.M.)
| | - Matthias K. Bernhard
- Division of Neuropediatrics, Hospital for Children and Adolescents, Department of Women and Child Health, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany; (M.K.B.); (A.M.)
| | - Ina Sterker
- Department of Head and Dental Medicine, Hospital for Ophthalmology, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany
| | - Wieland Kiess
- Division of Neuropediatrics, Hospital for Children and Adolescents, Department of Women and Child Health, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany; (M.K.B.); (A.M.)
| | - Janina Gburek-Augustat
- Division of Neuropediatrics, Hospital for Children and Adolescents, Department of Women and Child Health, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany; (M.K.B.); (A.M.)
| | - Andreas Merkenschlager
- Division of Neuropediatrics, Hospital for Children and Adolescents, Department of Women and Child Health, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany; (M.K.B.); (A.M.)
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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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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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Tereshchenko AV, Trifanenkova IG, Vydrina AA. [Botulinum therapy for acute esotropia]. Vestn Oftalmol 2022; 138:31-36. [PMID: 35488560 DOI: 10.17116/oftalma202213802131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the effectiveness of the use of botulinum toxin type A in the treatment of acute esotropia in children. MATERIAL AND METHODS A retrospective analysis of the results of using botulinum toxin type A in the treatment of acute convergent strabismus in 16 children was performed. Children's ages ranged from 3 to 15 years. Botulinum toxin was injected into the medial rectus muscles. In 6 patients with acute esotropia, botulinum toxin was injected into the internal rectus muscle of both eyes, in the rest of patients the toxin was injected into one eye. Two patients underwent chemodenervation of extraocular muscles twice. The injected dose of botulinum toxin (from 1 to 5 U) was chosen depending on the strabismus angle, the patient's age, and the duration of the disease. In order to form binocular vision, all patients underwent orthopto-diploptic treatment. The observation period lasted 12 to 18 months. RESULTS One month after chemodenervation, the orthoposition of the eyes was persistently restored in 7 children (43.75%). Esodeviation angle decreased steadily to 2 degrees in 4 patients (25%). A second injection of botulinum toxin was required to achieve orthotropy in 2 patients (12.5%) 4-6 months after chemodenervation. An increase of esodeviation angle was recorded in 3 patients (18.75%), which required classical surgical treatment of strabismus. One month after the injection, unstable binocular vision developed in 11 children (68.75%). After 1 year, binocular vision was successfully formed 13 patients (81.25%). CONCLUSION Chemodenervation in the majority of children with acute esotropia led to persistent orthoposition of the eyes. This created favorable conditions for the restoration of binocular vision during subsequent orthopto-diploptic treatment.
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Affiliation(s)
- A V Tereshchenko
- Kaluga branch of S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Kaluga, Russia
| | - I G Trifanenkova
- Kaluga branch of S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Kaluga, Russia
| | - A A Vydrina
- Kaluga branch of S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Kaluga, Russia
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Yabanoğlu D, Taylan Şekeroğlu H. How to Manage a Strabismus Clinic During the COVID-19 Pandemic; What is Really Urgent, What is Not?: A Single-Center Case Series from Turkey. Turk J Ophthalmol 2022; 52:96-101. [PMID: 35481730 PMCID: PMC9069093 DOI: 10.4274/tjo.galenos.2021.69263] [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] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate the management of the pediatric ophthalmology and strabismus clinic when strict quarantine conditions were adopted during the coronavirus disease 2019 (COVID-19) pandemic in Turkey. Materials and Methods: The study presents a review of the patients examined during the quarantine period. All patients were assessed with the highest possible level of personal protection. Results: Ten patients (6 girls, 4 boys) with a mean age of 9 years (range: 2-16) were evaluated. The patients presented 3-20 days after symptom onset. Ocular misalignment and diplopia were the main symptoms. Four of the 10 patients were diagnosed with sixth cranial nerve palsy and three patients were diagnosed with acute-onset comitant esotropia. Six patients had significant cranial magnetic resonance imaging findings. Conclusion: Acute-onset neurological conditions are more common during the COVID-19 pandemic. These reports will contribute to global experience and understanding of COVID-19.
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Affiliation(s)
- Demet Yabanoğlu
- Hacettepe University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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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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Gietzelt C, Fricke J, Neugebauer A, Hedergott A. Prism adaptation test before strabismus surgery in patients with decompensated esophoria and decompensated microesotropia. Int Ophthalmol 2022; 42:2195-2204. [PMID: 35038124 PMCID: PMC9287201 DOI: 10.1007/s10792-022-02219-3] [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: 09/04/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate the effect of Prism adaptation test (PAT) on the angle of squint in decompensated esophoria (decEPH) and decompensated microesotropia (decMET). Methods In this single-center retrospective study we reviewed the medical records of patients with the diagnosis of decEPH or decMET, aged at least 12 years, who were treated by strabismus surgery for the first time. The maximum Angle of squint (AOS) for far (F) and near (N) fixation and PAT results before surgery, as well as AOS (F) and AOS (N) after surgery and results of binocular function tests were considered. PAT included wearing a prism based on the largest angle for over 60 min. Results 100 patients (mean age 37 ± 17 years) were included in the decEPH group, 82 patients (mean age 30 ± 13 years) in the decMET group. For decEPH, before surgery AOS was 25.5 ± 8.8 pdpt (F) and 23.5 ± 9.8 pdpt (N). During PAT the AOS increased significantly by 2.7 ± 4.3 to 28.2 ± 8.6 pdpt (F) and by 4.9 ± 4.5 to 28.3 ± 9.5 pdpt (N). Altogether, in 82% of decEPH patients AOS (F) and/ or AOS (N) in- or decreased by at least 3 pdpt. For decMET, before surgery AOS was 28.6 ± 10.8 pdpt for far (F) and 30.9 ± 11.8 pdpt for near fixation (N). During PAT the AOS increased significantly by 4.2 ± 5.8 to 32.5 ± 9.5 pdpt (F) and by 3.7 ± 6.1 to 34.4 ± 9.5 pdpt (N). Altogether, in 51% of decMET patients, AOS (F) and/ or AOS (N) increased by at least 10 pdpt, therefore more than 5° which would have been maximally expected from mictrotropia, or decreased by at least 3 pdpt. Conclusions The Prism adaptation test (PAT) showed remarkable changes in AOS in both decEPH and decMET. In patients with decEPH, the preoperative assessment of the “true AOS” under PAT reflects a pivotal requirement for successful strabismus surgery, as 82% had dose relevant angle changes ≥ 3 pdpt. For patients with decMET the preoperative prism adaptation test is especially of diagnostic value, but also 51% of decMET patients had changes in AOS beyond the expected microtropic angle (≥ 10 pdpt) or even a dose relevant angle decrease (≥ 3pdpt).
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Affiliation(s)
- Caroline Gietzelt
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Julia Fricke
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Antje Neugebauer
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Andrea Hedergott
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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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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Gisselbaek S, Hoeckele N, Klainguti G, Kaeser PF. Clinical Classification of Acquired Concomitant Esotropia. Klin Monbl Augenheilkd 2021; 238:482-487. [PMID: 33930923 DOI: 10.1055/a-1425-5017] [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 Classification and management of acquired concomitant esotropia is controversial. We sought to establish a simple clinical classification in order to determine in which cases further investigations in search of underlying pathologies are necessary. PATIENTS AND METHODS Observational retrospective study of the files of 175 consecutive patients examined in our unit between 2009 and 2018 for acute convergent strabismus. One hundred and nine patients were selected, after exclusion of infantile, incomitant, or mechanical esotropias, residual esotropias, and patients examined on a single occasion. All patients received a complete orthoptic and ophthalmological examination. We grouped the patients according to their common characteristics. RESULTS We established the following categories: 1. Acute esotropia of large angle (20 to 45 prism diopters [PD]), accompanied by mild hyperopia (mean 1.2 D) in children (n = 16) and moderate myopia (mean 3.7 D) in adolescents and adults (n = 13). 2. Decompensated micro-esotropia, which is distinguished from the other categories by the presence of abnormal retinal correspondence (n = 33). 3. Decompensated esophoria, with intermittent deviations of 5 to 30 PD, esotropia being compensated part of the time (n = 25). 4. Esotropia present only at a distance in patients over 50 years of age (n = 20). 5. Small-angle esotropia (< 15 PD) greater at a distance, associated with oculomotor cerebellar syndrome (n = 2). Complementary examinations (MRI or CT scan) were performed on 21 patients, leading to the discovery of a posterior fossa astrocytoma in a 4-year-old boy. CONCLUSIONS The recognition of decompensated micro-esotropia and esophoria, as well as distance esotropia of the elderly, avoids unnecessary additional investigations, which are indicated in any type of acute comitant strabismus if associated with any neurological sign or symptom (e.g., headaches, nausea, vertigo, imbalance, poor coordination, nystagmus, or papilledema). In the absence of neurological findings, there is no consensus about the indication of neuroimaging in large-angle acquired concomitant esotropia, but long-term follow-up of patients that do not undergo neuroimaging is strongly recommended in order to identify later occurring intracranial diseases. This is of particular importance with children.
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Affiliation(s)
- Sara Gisselbaek
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Nicole Hoeckele
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Georges Klainguti
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Pierre-François Kaeser
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
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Kang W, Kim WJ. Surgical Outcomes of Medial Rectus Recession and Lateral Rectus Resection for Large-angle Deviations of Acute Acquired Concomitant Esotropia. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 35:101-106. [PMID: 33596626 PMCID: PMC8046610 DOI: 10.3341/kjo.2020.0052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 02/14/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose This study aimed to evaluate the surgical outcomes of unilateral medial rectus recession and lateral rectus resection (R&R) for patients with large-angle deviations of acute acquired concomitant esotropia (AACE) without a neurological disease. Further, we have also suggested the surgical dosage of R&R for large-angle deviations of AACE. Methods This was a retrospective study of patients with AACE who underwent surgery and followed up after surgery for at least 6 months between September 2016 and March 2020. Among them, patients with ocular deviations of ≥30 prism diopters (PD) who underwent unilateral R&R were included. Results Seventeen patients with AACE were enrolled in this study (mean age, 23.5 years; four females). The mean amount of deviation was 40.00 PD at distance and near (range, 30–55 PD). Fifteen patients (88.2%) had myopia. The mean interval between the initial visit and surgery was 7.7 months (range, 4–20 months). All included patients had resolved diplopia after the surgery. Most patients with decreased stereoacuity displayed stereoacuity recovery after surgical treatment. At the final visit (mean follow-up period, 12.8 months), the mean angle of esodeviation was 0.82 PD (range, 6–0 PD) at distance and 0.47 PD (range, 4–0 PD) near. No patient displayed over-correction or adduction limitations in the operated eye. Conclusions The unilateral R&R procedure presented favorable surgical outcomes for patients with large-angle deviations of AACE. These results and proposed surgical dosage guidelines may be useful for surgeons in planning the surgical treatment of large-angle deviations of AACE.
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Affiliation(s)
- Wonki Kang
- Department of Ophthalmology, Yeungnam University Medical Center, Daegu, South Korea
| | - Won Jae Kim
- Department of Ophthalmology, Yeungnam University Medical Center, Daegu, South Korea
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Armenti ST, Miller JML, Gomez-Hassan D, Gappy C, Cornblath WT. Multiple sclerosis presenting as acute acquired comitant esotropia in a pediatric patient. J AAPOS 2021; 25:45-47. [PMID: 33144200 DOI: 10.1016/j.jaapos.2020.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 12/01/2022]
Abstract
Acute acquired comitant esotropia (AACE) is a rare form of esotropia in the older pediatric population. Although the workup for pediatric AACE varies, patients often do not undergo lab testing and imaging, because the overwhelming majority of cases are idiopathic. We describe AACE as the presenting manifestation of multiple sclerosis in a pediatric patient. His only other finding was a horizontal jerk nystagmus isolated to end gaze. Magnetic resonance imaging revealed extensive demyelinating lesions, with a small thalamic lesion possibly accounting for his esotropia. Our case underscores the need for extensive diagnostic workup for any ophthalmic or neurologic findings or symptoms accompanying AACE.
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Affiliation(s)
- Stephen T Armenti
- Kellogg Eye Center, Department of Ophthalmology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jason M L Miller
- Kellogg Eye Center, Department of Ophthalmology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Diana Gomez-Hassan
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Christopher Gappy
- Kellogg Eye Center, Department of Ophthalmology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Wayne T Cornblath
- Kellogg Eye Center, Department of Ophthalmology, University of Michigan Medical School, Ann Arbor, Michigan; Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan.
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Yun YI, Jung JH. Acute Acquired Comitant Esotropia Associated with Chiari I Malformation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.8.977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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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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Topcu Yilmaz P, Ural Fatihoglu Ö, Sener EC. Acquired Comitant Esotropia in Children and Young Adults: Clinical Characteristics, Surgical Outcomes, and Association With Presumed Intensive Near Work With Digital Displays. J Pediatr Ophthalmol Strabismus 2020; 57:251-256. [PMID: 32687210 DOI: 10.3928/01913913-20200422-02] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/14/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the clinical characteristics and surgical outcomes of acquired comitant esotropia with symptomatic diplopia. METHODS The clinical features and surgical outcomes of 27 patients with diplopia due to acquired comitant esotropia were retrospectively reviewed. Exclusion criteria were a history of prematurity, cerebral palsy, head trauma, or febrile illness before the onset of acquired comitant esotropia, incomitant strabismus, accommodative spasm, and divergence paralysis. Neurological evaluation and neuroimaging was normal in all patients. RESULTS Mean age at onset of esotropia and diplopia was 17.8 ± 10.3 years (range: 6 to 44 years). Eighteen patients had simple myopia (range: -0.25 to -7.75 diopters [D]), 5 patients had hypermetropia (range: 0.50 to 1.50 D), and 4 patients had emmetropia. The angle of deviation prior to surgery was 35.6 ± 10.3 prism diopters (PD) for far and 38.0 ± 10.5 PD for near fixation. Twenty-three patients (85%) were prism responders. A history of excessive near work (≥ 4 hours a day) with digital displays was present in 21 (78%) patients. Diplopia resolved and some level of stereovision was achieved in all patients postoperatively. Three patients had recurrence of esotropia in long-term follow-up. CONCLUSIONS The differentiation of a serious pathology from a straightforward optically or medically treatable condition in patients with a subacute or chronic history of diplopia is challenging for the clinician. The recognition of acquired comitant esotropia due to presumed intensive near activities with digital display may avoid time-consuming and costly laboratory investigations. Most of the patients in this series were prism responders and surgery for the prism-adapted angle was successful in restoring binocular vision. [J Pediatr Ophthalmol Strabismus. 2020;57(4):251-256.].
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Dotan G, Keshet Y, Qureshi HM, Friling R, Yahalom C. When pediatric acute acquired comitant esotropia is not caused by a neurological disease. J AAPOS 2020; 24:5.e1-5.e5. [PMID: 31923623 DOI: 10.1016/j.jaapos.2019.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/22/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acute acquired comitant esotropia (AACE) is a relatively rare type of pediatric strabismus, often described as a possible presentation of intracranial pathology. The risk of having neurological disease in isolated AACE is not clear, because many previously published cases had other neurological or ophthalmological abnormalities. The purpose of this study was to analyze the incidence of neurological abnormalities in children presenting with AACE and otherwise normal neurological and ophthalmological evaluations. METHODS The medical records of consecutive patients >4 years of age with AACE examined by a single practitioner from 2014 to 2018 were reviewed retrospectively. The main outcome measure was the presence of neurological disease. Children with duction deficits, incomitant esodeviations, and hyperopia of >2.00 D were excluded. RESULTS A total of 20 children (11 males; mean age, 9.8 ± 4.1 years) were included. Mean esodeviation was 29.5Δ ± 14.8Δ (range, 10Δ-55Δ). All had an otherwise normal ophthalmological and neurological evaluations. Of the 20, 19 (95%) had normal brain neuroimaging. One child that did not have neuroimaging was followed over 2 years without developing any neurological sequelae. CONCLUSIONS In our study cohort, pediatric AACE not accompanied by other ophthalmic and neurological abnormalities was not a manifestation of intracranial pathology. In such cases, the decision to perform neuroimaging should take into account other factors, including caregivers' preferences and availability for close monitoring.
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Affiliation(s)
- Gad Dotan
- Department of Opthalmology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yariv Keshet
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
| | - Hanya M Qureshi
- Columbia College, Columbia University in the City of New York
| | - Ronit Friling
- Department of Opthalmology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Claudia Yahalom
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Clinical characteristics and surgical outcomes of adults with acute acquired comitant esotropia. Jpn J Ophthalmol 2019; 63:483-489. [PMID: 31549267 DOI: 10.1007/s10384-019-00688-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [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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Mehta A, Greensher JE, Dahl GJ, Miller KE. Acute Onset Esotropia From Excessive Smartphone Use in a Teenager. J Pediatr Ophthalmol Strabismus 2018; 55:e42-e44. [PMID: 30571837 DOI: 10.3928/01913913-20181017-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/03/2018] [Indexed: 11/20/2022]
Abstract
Acute acquired comitant esotropia secondary to smart-phone use is a newly described phenomenon. This case report describes a boy with acute acquired comitant esotropia due to prolonged smartphone use who had improvement in binocular function after cessation of near work for several weeks. [J Pediatr Ophthalmol Strabismus. 2018;55:e42-e44.].
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