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Wang H, Zheng W. Effect of the prism and Maddox rod test as the surgical target for type III acute acquired comitant esotropia. Front Med (Lausanne) 2024; 11:1389201. [PMID: 38686368 PMCID: PMC11056567 DOI: 10.3389/fmed.2024.1389201] [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: 02/21/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction This study aims to explore more accurate and efficient examination methods to provide precise target surgical measurements for patients with type III acute acquired comitant esotropia (AACE). Methods The study conducted a retrospective analysis of 108 patients diagnosed with AACE who received surgical treatment at the Department of Ophthalmology, the First Affiliated Hospital of Fujian Medical University, from January 2018 to September 2023. All patients underwent examinations of the deviation angle, including the Hirschberg test, prism and Maddox rod test (PMT), and prism and alternate cover test (PACT). For the PACT, the minimum value (PACTmin) and maximum value (PACTmax) were obtained based on differences in examination methods, as well as the deviation angle range (PACT range), which represents the difference between PACTmax and PACTmin. Postoperatively, these patients were followed up for at least 6 months to assess changes in eye position and whether diplopia symptoms recurred. Results In both near and distant examinations, the results of PACTmax were significantly greater than those of PACTmin (p < 0.001), while the deviation angles obtained from PACTmax and PMT showed no significant statistical difference [p = 0.689 (33 cm), p = 0.436 (5 m)]. There was a strong linear correlation between PACTmin and PMT at both near (R = 0.8887) and distant (R = 0.8950) distances, but each PACTmin corresponded to multiple PMT values. There was no significant difference between the results of PACT range at near and distant distances (p = 0.531). The deviation angles obtained by PMT and PACTmin significantly decreased postoperatively compared to preoperative values, and diplopia disappeared in all patients, with alternative cover test showing no movement or presenting as an esophoria state. Conclusion The PMT can provide precise target surgical measurements for type III AACE, making it a fast, effective, and cost-efficient examination method. It is worthy of being promoted and applied in clinical practice.
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Affiliation(s)
- Huihang Wang
- Department of Ophthalmology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Ophthalmology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Weidong Zheng
- Department of Ophthalmology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Ophthalmology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Côté E, Reginald YA, Wan MJ. Risk of serious intracranial pathology in children presenting with acute acquired comitant esotropia. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00001-2. [PMID: 38281727 DOI: 10.1016/j.jcjo.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/05/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Acute acquired comitant esotropia (AACE) is defined as a sudden-onset constant nonaccommodative esodeviation. The purpose of this study was to determine the risk of serious intracranial pathology in children presenting with AACE. DESIGN Retrospective observational cohort study. SETTING Tertiary care pediatric hospital. METHODS The study included consecutive children who met the diagnostic criteria for AACE and had neuroimaging at a tertiary care pediatric hospital between 2000 and 2020. Patients were identified by searching the radiology database for all children who underwent neuroimaging for esotropia. The primary outcome measure was the proportion of patients with serious intracranial pathology. Secondary outcomes included risk factors for finding likely causative intracranial pathology and the proportion of patients with incidental findings. RESULTS A total of 107 patients met the inclusion criteria. Most of the patients (75.7%) had normal neuroimaging. The next most common result was an incidental finding unrelated to the esotropia (18.7%). Five patients (4.7%) had findings with uncertain contribution to esotropia, including 3 cases of type I Chiari malformation. A serious intracranial pathology was found in 1 patient (0.9%) who had a cerebellar medulloblastoma. CONCLUSION In this large series of pediatric patients with AACE who underwent neuroimaging, there was a small but nontrivial risk of serious intracranial pathology. In these patients, it is advisable either to obtain neuroimaging or to monitor closely for the development of concerning signs or symptoms.
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Affiliation(s)
- Elie Côté
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON
| | - Y Arun Reginald
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON
| | - Michael J Wan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON..
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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] [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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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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Kaur K, Muralikrishnan J, Hussaindeen JR, Deori N, Gurnani B. Impact of Covid-19 on Pediatric Ophthalmology Care: Lessons Learned. Pediatric Health Med Ther 2023; 14:309-321. [PMID: 37849985 PMCID: PMC10578174 DOI: 10.2147/phmt.s395349] [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: 06/27/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
The COVID-19 pandemic came with many new challenges that forced personal and professional lifestyle modifications. Medical facilities were in scarcity against this new unknown enemy and were challenged with the overloaded patient flow, scarcity of healthcare staff, and evolving treatment modalities with a better understanding of the virus each day. Ophthalmology as a "branch of medicine" suffered challenges initially because of a lack of guidelines for patient management, close working distance during routine examinations, and halt of major surgeries, including cataracts. Pediatric ophthalmology had major implications, as reduced outpatient visits would mean deeper amblyopia, and changed lifestyles, including online classes and home refinement, predisposing children to myopia, digital eye strain, and worsening of strabismus. COVID-19 also unveiled underlying accommodation and convergence anomalies that predisposed pediatric and adolescent patients to an increased prevalence of headache and acute onset esotropia. Teleophthalmology and other innovative solutions, including the use of prism glasses, safe slit-lamp shields, alternative ways of school screening with the use of photoscreeners, performing retinoscopy only when needed, and using autorefractors were among the few guidelines or modifications adopted which helped in the efficient and safe management of pediatric patients. Many pediatric ophthalmologists also suffered in terms of financial constraints due to loss of salary or even closure of private practices. School screening and retinopathy of prematurity screening suffered a great setback and costed a lot of vision years, data of which remains under-reported. Important implications and learnings from the pandemic to mitigate future similar situations include using teleophthalmology and virtual platforms for the triage of patients, managing non-emergency conditions without physical consultations, and utilizing home-based vision assessment techniques customized for different age groups. Though this pandemic had a lot of negative implications, the innovations, modifications, and other important learnings helped pediatric ophthalmologists in navigating safely.
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Affiliation(s)
- Kirandeep Kaur
- Children Eye Care Center, Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Chitrakoot, Madhya Pradesh, India
| | - Janani Muralikrishnan
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Chennai, India
| | | | - Nilutparna Deori
- Department of Pediatric Ophthalmology and Strabismus, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Bharat Gurnani
- Department of Cornea and Refractive Services, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Chitrakoot, Madhya Pradesh, India
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Zhang MD, Liu XY, Sun K, Qi SN, Xu CL. Acute acquired concomitant esotropia with congenital paralytic strabismus: A case report. World J Clin Cases 2023; 11:6476-6482. [PMID: 37900252 PMCID: PMC10601007 DOI: 10.12998/wjcc.v11.i27.6476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/16/2023] [Accepted: 08/02/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND An unusual case of acute acquired concomitant esotropia (AACE) with congenital paralytic strabismus in the right eye is reported. CASE SUMMARY A 23-year-old woman presented with complaints of binocular diplopia and esotropia of the right eye lasting 4 years and head tilt to the left since 1 year after birth. The Bielschowsky head tilt test showed right hypertropia on a right head tilt. She did not report any other intracranial pathology. A diagnosis of AACE and right congenital paralytic strabismus was made. Then, she underwent medial rectus muscle recession and lateral rectus muscle resection combined with inferior oblique muscle myectomy in the right eye. One day after surgery, the patient reported that she had no diplopia at either distance or near fixation and was found to be orthophoric in the primary position; furthermore, her head posture immediately and markedly improved. CONCLUSION In future clinical work, in cases of AACE combined with other types of strabismus, we can perform conventional single surgery for both at the same time, and the two types of strabismus can be solved simultaneously.
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Affiliation(s)
- Meng-Di Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Xiang-Yu Liu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Ke Sun
- Department of Anesthesiology, Jilin Province People’s Hospital, Changchun 130021, Jilin Province, China
| | - Shou-Nan Qi
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Chun-Ling Xu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130022, Jilin Province, China
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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] [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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8
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Zhu M, Tang Y, Wang Z, Shen T, Qiu X, Yan J, Chen J. Clinical characteristics and risk factors of acute acquired concomitant esotropia in last 5 years: a retrospective case-control study. Eye (Lond) 2023; 37:320-324. [PMID: 35075284 PMCID: PMC9873604 DOI: 10.1038/s41433-022-01939-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/17/2021] [Accepted: 01/13/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES A remarkable increase in the number and proportion of surgical patients with acute acquired concomitant esotropia (AACE) has been noted in our hospital in recent years. We aimed to analyse the clinical characteristics and associated risk factors of this increasing number of strabismus in last 5 years. METHODS Medical information was obtained in 62 AACE patients and 73 orthotropic patients as control group completed questionnaires and examination items from March 2017 to May 2020. Data included age at onset, refractive error, angle of deviation, binocular vision, eye care habits, and optical quality of spectacles. RESULTS Of the 62 AACE patients, the mean ± standard deviation age at onset was 25.3 ± 8.5 years, with 47 (75.8%) cases showing myopia, 9 (14.5%) showing emmetropia, and 6 (9.7%) showing hypermetropia. Among the AACE patients, 35 (56.5%) performed >8 h of close work daily and 36 (58.1%) reported late-night use of digital devices. When compared with the control group, the risk factors identified for AACE included long durations of close work (odds ratio [OR], 11.72; 95% confidence interval [CI], 3.53-38.91; P < 0.001) and immoderate late-night use of digital devices (OR, 14.29; 95% CI, 4.10-49.72; P < 0.001). CONCLUSION Our study demonstrated that young adults accounted for the majority of the growing number of individuals affected by AACE in last 5 years, and excessive close visual activities and immoderate late-night use of digital devices were found to be associated with the onset of AACE.
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Affiliation(s)
- Minyi Zhu
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Department of Ophthalmology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yan Tang
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Department of Ophthalmology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhonghao Wang
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Tao Shen
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xuan Qiu
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jianhua Yan
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jingchang Chen
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Sefi-Yurdakul N. Clinical features, etiological reasons, and treatment results in patients who developed acute acquired nonaccomodative esotropia. Int Ophthalmol 2023; 43:567-574. [PMID: 35994189 DOI: 10.1007/s10792-022-02458-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/31/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the clinical features, possible etiological reasons, and treatment results in children who developed acute acquired comitant esotropia (AACE) without strabismus in previous years. METHODS Medical records of the patients who were diagnosed with AACE between July 2017 and June 2021 were retrospectively reviewed. The children with ocular and orbital pathology, hypermetropia > 2.00 diopters, and anisometropia > 1.00 diopters were not included in the study. Possible etiological factors that could cause esotropia, treatment results, motor, and sensory functions were investigated. RESULTS The mean age at first admission, and the onset of AACE, was 8.8 ± 2.9 (4-13) years of three female (23.1%) and 10 male (76.9%) cases. The causes of AACE were determined to be occlusion of the eye due to corneal foreign body removal in one (7.7%), emotional stress in one case (7.7%), and excessive close work, on computer and smartphone screens in the other 11 cases (84.6%). Orthotropia was achieved in cases who underwent strabismus surgery (n = 10) and in cases using the prism (n = 2); except for one case, all (92.3%) achieved binocular single vision (100 s/arc stereopsis and fusion) after treatment, while there was no binocular single vision in any of the cases before treatment. CONCLUSIONS Acute acquired comitant esotropia is a rare clinical entity. Successful motor and sensory outcomes can be achieved by strabismus surgery or by prism therapy. It is critical to investigate the patientş with AACE in terms of intracranial pathologies, although rarely seen.
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Affiliation(s)
- Nazife Sefi-Yurdakul
- Başkent University Zübeyde Hanım Hospital-İzmir, Halk Sokak, No: 26, Sahilevleri-Narlıdere, İzmir, Turkey.
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Carter D, Pujara P, Bolton K, Nicholson R. Simultaneous Development of Acute Acquired Concomitant Esotropia in Two Siblings during the COVID-19 Pandemic: A Case Report. Br Ir Orthopt J 2023; 19:1-6. [PMID: 36818462 PMCID: PMC9912853 DOI: 10.22599/bioj.283] [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: 08/22/2022] [Accepted: 12/23/2022] [Indexed: 02/08/2023] Open
Abstract
Aim To report a case of two siblings who near-simultaneously developed a large angle concomitant esotropia during the COVID-19 pandemic, and to describe their treatment and outcomes. Method A 5-year-old boy and his 11-year-old sister were presented to the hospital eye service in early 2021, having both developed acute-onset large angle esotropia within three months of each other. Neither had any significant past medical, ophthalmic, or family history. The siblings lived in the same household, and both experienced lifestyle changes as a result of the UK lockdown in response to COVID-19. Results Each sibling was treated with right medial rectus recession (5.5 mm) and right lateral rectus resection (7 mm), and at a three-month follow-up, both were minimally esophoric with restored binocularity. Conclusion The unusual and abrupt changes in lifestyle imposed by the COVID-19 pandemic highlight the likelihood of an environmental aetiology for some forms of esotropia and raise the possibility that extended screen time may be a contributory factor.
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Affiliation(s)
| | | | - Kate Bolton
- Portsmouth Hospitals University NHS Trust, GB
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Shi C, Chen B, Yu X, Yao Z. Sensory eye dominance following surgically correction for acute acquired concomitant esotropia of adulthood. Eur J Ophthalmol 2023; 33:83-91. [PMID: 35578538 DOI: 10.1177/11206721221100906] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Acute acquired concomitant esotropia (AACE) is an unusual presentation characterized by acute onset of esotropia after infancy. For patients with AACE of adulthood, the outcome of surgery, which is a common treatment, often shows successful recovery of stereopsis. However, whether surgically corrected patients with AACE of adulthood achieved balanced eyes is yet unclear. METHODS Here, we used a binocular phase combination paradigm to quantitatively assess the ocular dominance of 22 surgically aligned patients with AACE of adulthood, which all had regained normal stereopsis after the surgery and 14 adult controls with normal vision. The sensory eye dominance was quantified as the interocular contrast ratio, termed balance point, at which each eye contributed equally to the perception of cyclopean grating. RESULTS We found that, normal controls had a mean balance point value close to unity (0.96 ± 0.01), whereas adult AACE patients exhibited apparent interocular imbalance (0.76 ± 0.04), which was significantly different from control group (Mann-Whitney U = 135, P < 0.001, two tailed). In addition, the balance point of adults with AACE didn't correlate with the interval between onset of esotropia and the surgery (r = - 0.262, p = 0.239), or the length of postoperative follow-up period (r = 0.127, p = 0.575). CONCLUSION Our results suggest that, for patients with AACE of adulthood whose eyes had been straightened, there is still residual sensory imbalance which may be a potential risk factor for AACE of adulthood.
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Affiliation(s)
- Chennan Shi
- School of Ophthalmology and Optometry and Eye hospital, 26453Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Ophthalmology, Optometry and Vision Science, 26453Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Bo Chen
- School of Ophthalmology and Optometry and Eye hospital, 26453Wenzhou Medical University, Wenzhou, Zhejiang, China.,the Brain Cognition and Brain Disease Institute (BCBDI), 85411Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xinping Yu
- Zhongshan Ophthalmic Center, 194038Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhimo Yao
- School of Ophthalmology and Optometry and Eye hospital, 26453Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Ophthalmology, Optometry and Vision Science, 26453Wenzhou Medical University, Wenzhou, Zhejiang, China
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Yagasaki T, Yokoyama Y, Yagasaki A, Eboshita R, Tagami K, Haga Y, Touya A. Surgical Outcomes with and without Prism Adaptation of Cases with Acute Acquired Comitant Esotropia Related to Prolonged Digital Device Use. Clin Ophthalmol 2023; 17:807-816. [PMID: 36937166 PMCID: PMC10017831 DOI: 10.2147/opth.s403300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023] Open
Abstract
Purpose To analyze surgical results of 32 cases with acute acquired comitant esotropia (AACE) related to prolonged use of digital devices (DDs). Patients and Methods Medical records of cases with AACE related to prolonged use of DDs that had undergone surgery were retrospectively revised. Complete medical history and full ophthalmological examinations before and surgery were obtained for all cases. All cases also underwent neurological examinations using brain and orbital imaging. Motor success was considered as alignment within 10 prism diopters (Δ) at both near and distance. Sensory success was defined as stereopsis ≤60 arcsec. Nineteen cases (Group S) underwent surgery alone and 13 cases were treated with surgery and prism adaptation (Group S+P). Motor and sensory outcomes were compared between groups. Results Mean age at first visit was 22.0 ± 9.0 years and mean daily use of DDs use was 6.3 ± 3.4 hours. Mean angle of preoperative alignment for distance and near were 26.5 ± 13.0Δ and 24.6 ± 16.4Δ, respectively. Surgery was performed at a mean of 23.3 ±3.5 years old and mean angle of alignment at final examination for distance and near were 5.8 ± 7.7Δ and 3.5 ± 5.7Δ, respectively. Final motor and sensory success rate were 84% and 53%, respectively. No significant differences in motor or sensory outcomes were evident between groups at initial or last visit. Conclusion Favorable motor and sensory outcomes were achieved with surgical intervention with and without prism adaptation for AACT related to prolonged use of DDs.
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Affiliation(s)
- Teiji Yagasaki
- Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Aichi, Japan
- Correspondence: Teiji Yagasaki, Yagasaki Eye Clinic, 62-6 Gonaka, Kaimei, Ichinomiya, Aichi, 494-0001, Japan, Tel +81-586-61-8787, Fax +81-586-61-9210, Email
| | - Yoshimi Yokoyama
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Aichi, Japan
| | - Ayaka Yagasaki
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Aichi, Japan
- Department of Ophthalmology, Gifu Prefectural General Medical Center, Gifu, Gifu, Japan
| | | | | | - Yayoi Haga
- Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan
| | - Arisu Touya
- Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan
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Roda M, di Geronimo N, Valsecchi N, Gardini L, Fresina M, Vagge A, Fontana L, Schiavi C. Epidemiology, clinical features, and surgical outcomes of acute acquired concomitant esotropia associated with myopia. PLoS One 2023; 18:e0280968. [PMID: 37200284 DOI: 10.1371/journal.pone.0280968] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023] Open
Abstract
PURPOSE To analyze epidemiology, clinical features, and surgical outcomes of type III acute acquired concomitant esotropia (Bielschowsky esotropia (BE)). METHODS The medical charts of patients diagnosed with acquired concomitant esotropia between 2013 and 2021 were reviewed. Assessed data were age, gender, age at diplopia onset, age at the diagnosis, refraction, visual acuity, neuroimaging, diplopia onset, angle of deviation, stereopsis, surgical procedure, amount of surgery, and relapse of diplopia after surgery. Moreover, we investigated the correlation between the use of electronic devices and the onset of diplopia. RESULTS One hundred seventeen patients (mean age 35.07 ± 15.81 years) were included in the study. The mean delay to the diagnosis was 3.29 ± 3.62 years. Myopia range was 0 to 17 diopters spherical equivalent. 66,3% spent more than 4 hours a day using laptops, tablets, or smartphones at the onset of diplopia, and 90,6% presented a subacute onset. None showed neurologic signs or symptoms. Patients who underwent surgery were ninety-three, with a rate of surgical success of 93.6%, and a relapse rate of 17.2%. A negative correlation resulted between pre-operative deviation and age at diagnosis (ρ = -0.261; p<0.05), whereas factors associated with surgical failure were older age at diplopia onset (p = 0.042) and longer delay between onset and diagnosis (p = 0.002). CONCLUSION We registered an outstanding increase in prevalence of BE, which could be related to the exponential increase in the use of electronic devices for professional, educational, and recreational purposes. A prompt diagnosis and an augmented dose of surgery allows good motor and sensory results.
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Affiliation(s)
- Matilde Roda
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Natalie di Geronimo
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Nicola Valsecchi
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Gardini
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michela Fresina
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Aldo Vagge
- DINOGMI, Polyclinic Hospital San Martino IRCCS, University Eye Clinic, Genoa, Italy
| | - Luigi Fontana
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Costantino Schiavi
- Ophthalmology Unit, DIMEC, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Dragomir MS, Merticariu M, Merticariu CI. Management of acute acquired comitant esotropia in children. Rom J Ophthalmol 2023; 67:87-91. [PMID: 37089805 PMCID: PMC10117196 DOI: 10.22336/rjo.2023.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 04/25/2023] Open
Abstract
Aim: This report aims to discuss and review the diagnosis and management of acute acquired comitant esotropia (AACE) in children and to add several cases to the limited literature available on this unusual condition in the pediatric population. Materials and methods: We present two cases of AACE with large-angle deviations that were investigated and followed-up according to current recommendations. Both cases required strabismus surgery for AACE, but different procedures were chosen, with good postoperative results. Results: Unilateral recession of the medial rectus and resection of the lateral rectus (R&R) were performed in one case and bilateral medial rectus (MR) recession in the other, with resolution of the diplopia and full recovery of binocular vision. Discussion: Although isolated AACE is usually benign, studies have reported the presence of intracranial disease in up to 10% of cases, making it a potential first sign of an underlying serious pathology. Therefore, AACE should be investigated as a medical emergency and neuroimaging should be performed in all patients with unclear onset of AACE, as well as in those with associated neurological symptoms, such as headache, cerebellar imbalance, weakness, or nystagmus. Conclusion: Acute acquired comitant esotropia (AACE) is an infrequent type of esotropia that usually appears in older children. It is characterized by esotropia and diplopia with acute onset. Neurological examinations and neuroimaging should be performed to exclude any potential intracranial disease. Treatment of AACE without underlying neurological disease is focused on managing the diplopia and resolving the esotropia. Strabismus surgery has good motor and sensory results and can successfully restore good binocular function. Abbreviations: AACE = Acute acquired comitant esotropia, LR = lateral rectus, MR = medial rectus, PD = prism diopters, R&R = recession and resection, BSV = binocular single vision, PAT = prism adaptation test.
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Affiliation(s)
| | - Mircea Merticariu
- Department of Urology, CF2 Hospital, Bucharest, Romania
- "Titu Maiorescu" University of Medicine, Bucharest, Romania
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15
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Osborne D, Richardson-May J, Bush K, Evans M, West SK, May K, Self J. Four cases of acute comitant esotropia associated with diffuse intrinsic pontine glioma in children. Strabismus 2022; 31:26-30. [PMID: 36529745 DOI: 10.1080/09273972.2022.2143823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acute acquired concomitant esotropia (AACE) is usually a benign form of strabismus that infrequently is associated with intracranial pathology. Clinicians have noted an increase in its incidence and theorize that it may be related to public health "lockdown" measures taken in response to the COVID-19 pandemic. With an increased incidence of AACE clinicians must firstly differentiate AACE from common accommodative esotropia and secondly recognize AACE as a possible sign of serious neuropathology.Diffuse Intrinsic Pontine Glioma (DIPG) is a devastating diagnosis for affected families. Children typically present at age 6-7 years with cranial nerve palsies, long tract signs, and/or cerebellar signs. Diagnosis is made from characteristic findings on magnetic resonance brain imaging (MRI brain) and treatment includes radiotherapy and palliative care. Two years from diagnosis, 90% of affected children will have died from their disease. CASE SERIES We present four cases that attended our pediatric ophthalmology clinic with AACE either as a presenting sign of DIPG or as a clinical finding following a DIPG diagnosis. Patient A (age 5 years) presented to the emergency eye clinic with sudden onset diplopia and intermittent esotropia. Suppression later developed, they had 0.00 logMAR visual acuity either eye, and bilateral physiological hypermetropia. MRI brain imaging requested as a result of the unusual presentation led to the DIPG diagnosis. The other 3 cases (ages 11, 5 & 5 years) were assessed post DIPG diagnosis and found to have an esotropia measuring bigger on 1/3-meter fixation than 6-meter fixation, full ocular motility, physiological hypermetropia or emmetropia, and visual acuity normal for age. Other than patient B (age 11 years), who had papilledema and gaze evoked nystagmus when they were assessed 2 weeks prior to death, no patient had any other clinical eye findings. CONCLUSIONS This small series of 4 patients attending our clinic within a 12-month period supports the notion that children presenting with AACE should routinely be offered brain MRI. Not all children with DIPG-associated AACE have significant ophthalmic findings indicative of intracranial pathology. With the potential for increased incidence of AACE related to lockdowns, clinicians should be reminded of the infrequent possibility their patient has a more serious condition.
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Affiliation(s)
- D Osborne
- Department of Ophthalmology, University Hospital Southampton and University of Southampton, Hampshire
| | - J Richardson-May
- Ophthalmic Specialty Training Registrar year 4, Department of Ophthalmology, University Hospital Southampton, Hampshire
| | - K Bush
- Hampshire Hospitals Foundation Trust, Hampshire
| | - M Evans
- Orthoptist, University Hospital Southampton, Hampshire
| | - SK West
- Consultant ophthalmologist, University Hospital Southampton, Hampshire
| | - K May
- Consultant Ophthalmologist, University Hospital Southampton and University of Southampton, Hampshire
| | - J Self
- Consultant Ophthalmologist, University Hospital Southampton and University of Southampton, Hampshire
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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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Lim SH, Lee YG, Kim US. Non-adjustable surgery for acute acquired comitant esotropia under general anesthesia. BMC Ophthalmol 2022; 22:416. [PMID: 36320058 PMCID: PMC9623939 DOI: 10.1186/s12886-022-02634-1] [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: 03/20/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose: To investigate the surgical results of the non-adjustable suture technique under general anesthesia for the correction of acute acquired comitant esotropia. Study design: Retrospective case study. Methods: Patients with acute acquired comitant esotropia who underwent corrective surgery from September 2008 to June 2018 were included. Surgical treatment was conducted based on the measured maximum angle after occlusion for at least 1 h; all surgeries were performed using the non-adjustable suture technique under general anesthesia. Motor success was categorized into three groups: good, ortho; fair, 2 to 8 prism diopters (PD); and poor, over 8 PD. Sensory success was divided into two groups: good (no diplopia with binocular vision) and poor (no stereopsis with diplopia). Results: 40 patients (21 male and 19 female, 28.78 ± 15.32 years old) were included. Preoperative esodeviation was 28.0 ± 12.8 PD. Mean refractive error was − 2.5 ± 2.5 D (spherical equivalent). After the occlusion of one eye, 14 patients (35%) showed an esodeviation increase of more than 5 PD. There were 70% good, 25% fair, and 5% poor outcomes regarding motor success. 96% of the patients demonstrated good sensory success. Conclusion: The non-adjustable correction based on the maximum angle after 1 h had a relatively excellent motor and sensory success rate.
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Affiliation(s)
- Soo Hyun Lim
- grid.412484.f0000 0001 0302 820XDepartment of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoon Gon Lee
- grid.490241.a0000 0004 0504 511XKim’s Eye Hospital, Seoul, Republic of Korea
| | - Ungsoo Samuel Kim
- grid.254224.70000 0001 0789 9563Department of Ophthalmology, Gwangmyeong Hospital, Chung-Ang University, 110, Deokan-ro, 14353 Gwangmyeong-si, Gyeonggi-do Republic of Korea ,grid.254224.70000 0001 0789 9563Gwangmyeong Hospital, Chung-Ang University, 110, Deokan-ro, 14353 Gwangmyeong-si, Gyeonggi-do Republic of Korea
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18
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Ai L, Chen X, Guo R, Li J, Wang J, Feng Y, Guo Y, Wang J. Botulinum toxin treatment for bielschowsky acquired commitant esotropia in adults. BMC Ophthalmol 2022; 22:395. [PMID: 36195859 PMCID: PMC9533611 DOI: 10.1186/s12886-022-02612-7] [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: 07/10/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Many researchers have noticed that there is an increasing trend of Bielschowsky acquired comitant esotropia (ACE) in recent years related to excessive near work, but the exact pathogenesis and treatment methods have not been reported yet. Therefore, we aimed to characterize the clinical features of this ACE in adults and to evaluate the efficacy of botulinum toxin (BTX) injections in these patients. Methods This was a prospective consecutive case series of 47 patients with Bielschowsky ACE. BTX was injected bilaterally into the medial rectus muscle of 45 patients, and twenty-seven of them (27/45) completed 10 months of follow-up after their last injection. Angle of deviation, fusion, stereopsis, subjective assessment of diplopia were documented before and after BTX treatment, and repeated measures data were compared by the Wilcoxon signed-rank test or Analysis of variance. The relationship between BTX dosage and corrected esotropia was explored by the Regression analysis. Meanwhile, possible risk factors for ACE including time spent on near work, refraction error, patients’ personality, glasses wearing habits and duration of symptoms were recorded and analyzed with General Linear Models. Results The patients aged 32.32 ± 10.96 (range 15–53) years spent 8.34 ± 2.38 h on near work each day, and most myope habitually removed their glasses at near. Their chief complaint was distance diplopia, with more significant esotropia at distance (around 20 PD) than at near. This series of patients also exhibited perfectionist tendencies. However, most patients achieved orthophoria after BTX treatment, only with a mild residual esotropia (+ 3.96 ± 5.79 PD), which left them asymptomatic most of the time. Conclusion This group of ACE patients was characterized by diplopia with more significant esotropia at distance. Besides excessive near-work, habitually removing myopic glasses and perfectionist tendencies may also contribute to this type of ACE. Fortunately, bilateral BTX injection safely and effectively reduced the esotropia with complete resolution of symptoms, especially for those treated at an early stage. Supplementary information The online version contains supplementary material available at 10.1186/s12886-022-02612-7.
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Affiliation(s)
- Likun Ai
- Department of Ophthalmology, Beijing TongRen Hospital, Capital Medical University, Chongwenmen District, No.1 Dongjiaominxiang, 100730, Beijing, China.
| | - Xiaoli Chen
- Department of Ophthalmology, Fuxing Hospital, Capital Medical University, 100038, Beijing, China
| | - Ruilin Guo
- Department of Ophthalmology, Beijing TongRen Hospital, Capital Medical University, Chongwenmen District, No.1 Dongjiaominxiang, 100730, Beijing, China
| | - Jing Li
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China
| | - Jinghui Wang
- Department of Ophthalmology, Beijing TongRen Hospital, Capital Medical University, Chongwenmen District, No.1 Dongjiaominxiang, 100730, Beijing, China
| | - Yi Feng
- Department of Ophthalmology, Beijing TongRen Hospital, Capital Medical University, Chongwenmen District, No.1 Dongjiaominxiang, 100730, Beijing, China
| | - Yiqin Guo
- Department of Ophthalmology, Beijing TongRen Hospital, Capital Medical University, Chongwenmen District, No.1 Dongjiaominxiang, 100730, Beijing, China
| | - Jianan Wang
- Department of Ophthalmology, Beijing ShunYi KongGang Hostital, 101318, Beijing, China
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Merino P, Freire M, Yáñez-Merino J, Gómez de Liaño P. Surgical outcomes of acquired acute comitant esotropia. Causes and classification. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:558-564. [PMID: 35871999 DOI: 10.1016/j.oftale.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/22/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To study the results of surgical treatment of acquired concomitant esotropia and its posible causes. METHODS Retrospective study of the patients with acute acquired esotropia that were operated on since 2017. Distance and near horizontal deviation, spherical equivalent and the excessive use of the tablets and smartphones were analyzed. A good sensorial outcome was considered when stereopsis was recovered and good motor outcome if horizontal deviation was ≤10 prism diopters at the end of the follow-up. RESULTS A total of 15 cases were included (60% women), mean age: 29.07 years (86.66% ≥16 years). Mean time since the beginning of the symptoms to the surgery was 23.3 months. Mean horizontal preoperative deviation was 19.73 ± 7.2 pd at near and 22.93 ± 7.3 dp at distance decreasing to 3.33 ± 3.8 pd at near and 3.86 ± 3.9 pd at distance (P < .001). The 66.6% had diplopía. The 46.66% had decompensated esophoria or microesotropia, 86,66 % myopia and the 33.33% referred excesive use of the tablets and smartphones. The medial rectus recession were done in 10 cases. A good motor outcome was obtained in the 93.33% of the cases and sensorial outcome in the 53.3% without diplopía. CONCLUSION Surgery was an excellent treatment to resolve the deviation and diplopia. The esophorias and microesotropias represented near the half of the cases and the excesive use of the tablets and smartphones were the third part of the sample. Most of the patients had myopia.
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Affiliation(s)
- P Merino
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid, Spain.
| | - M Freire
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid, Spain
| | - J Yáñez-Merino
- Departamento de Oftalmología, Hospital Miguel Servet, Zaragoza, Spain
| | - P Gómez de Liaño
- Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid, Spain
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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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22
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Zhu M, Tang Y, Wang Z, Shen T, Qiu X, Yan J, Chen J. Clinical characteristics and risk factors of acute acquired concomitant esotropia in last 5 years: a retrospective case-control study. Eye (Lond) 2022. [PMID: 35075284 DOI: 10.1037/s41433-022-01939-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES A remarkable increase in the number and proportion of surgical patients with acute acquired concomitant esotropia (AACE) has been noted in our hospital in recent years. We aimed to analyse the clinical characteristics and associated risk factors of this increasing number of strabismus in last 5 years. METHODS Medical information was obtained in 62 AACE patients and 73 orthotropic patients as control group completed questionnaires and examination items from March 2017 to May 2020. Data included age at onset, refractive error, angle of deviation, binocular vision, eye care habits, and optical quality of spectacles. RESULTS Of the 62 AACE patients, the mean ± standard deviation age at onset was 25.3 ± 8.5 years, with 47 (75.8%) cases showing myopia, 9 (14.5%) showing emmetropia, and 6 (9.7%) showing hypermetropia. Among the AACE patients, 35 (56.5%) performed >8 h of close work daily and 36 (58.1%) reported late-night use of digital devices. When compared with the control group, the risk factors identified for AACE included long durations of close work (odds ratio [OR], 11.72; 95% confidence interval [CI], 3.53-38.91; P < 0.001) and immoderate late-night use of digital devices (OR, 14.29; 95% CI, 4.10-49.72; P < 0.001). CONCLUSION Our study demonstrated that young adults accounted for the majority of the growing number of individuals affected by AACE in last 5 years, and excessive close visual activities and immoderate late-night use of digital devices were found to be associated with the onset of AACE.
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Affiliation(s)
- Minyi Zhu
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Department of Ophthalmology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yan Tang
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Department of Ophthalmology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhonghao Wang
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Tao Shen
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xuan Qiu
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jianhua Yan
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jingchang Chen
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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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] [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] [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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Hashemi H, Nabovati P, Yekta AA, Agha Mirsalim M, Rafati S, Ostadimoghaddam H, Khabazkhoob M. Binocular vision disorders in a geriatric population. Clin Exp Optom 2021; 105:539-545. [PMID: 34016028 DOI: 10.1080/08164622.2021.1922065] [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: 10/21/2022] Open
Abstract
Clinical relevance: A population-based epidemiological survey is important to help establish the frequency of binocular vision disorders in a geriatric population. Such data will be useful to clinicians and help guide diagnostic testing for this age group.Background: To determine the prevalence of binocular vision disorders and their associations with age and sex in the geriatric population.Methods: This report is a part of the Tehran Geriatric Eye study (TGES); a population-based cross-sectional study conducted on residents over 60 years of age in Tehran, Iran, using random stratified cluster sampling. A total of 165 clusters were selected (proportionally to size) from 22 strata of Tehran city. All participants underwent a complete ocular examination including the measurement of visual acuity, refraction, unilateral and alternating cover tests, and the Worth 4-dot suppression test. Strabismus was defined as the presence of constant unilateral or alternating esotropia or exotropia at either near (40 cm) or far (6 m). Distance and near exophoria were defined as more than 3Δ and 9Δ of exophoria at 6 m and 40 cm, respectively. Distance and near esophoria were defined as more than 1Δ and any amount of esophoria at 6 m and 40 cm, respectively.Results: Statistical analysis was performed on the data of 2,227 participants. The mean age of the participants was 66.6 ± 5.4 years and 59.4% were female. The prevalence of distance exophoria, esophoria, and hyperphoria was 8.9%, 0.34%, and 0.29%, respectively. The prevalence of near exophoria, esophoria, and hyperphoria was 32.4%, 0.61%, and 0.37%, respectively. The prevalence of distance exotropia and esotropia was 1.3% and 0.63%, respectively. The prevalence of near exotropia and esotropia was 4.6% and 0.59%, respectively.Conclusion: Non-strabismic binocular vision disorders were prevalent in an elderly population. Exo deviations were more prevalent than eso deviations.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Payam Nabovati
- Rehabilitation Research Center, Department of Optometry, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Ali Yekta
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran.,Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shokoofeh Rafati
- Rehabilitation Research Center, Department of Optometry, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Garone G, Ferro V, Barbato M, Vanacore N, Papini L, Pro S, Boni A, Scialanga B, Nacca R, Evangelisti M, Di Nardo G, Parisi P, Raucci U. Acute strabismus in neurological emergencies of childhood: A retrospective, single-centre study. Eur J Paediatr Neurol 2021; 32:80-85. [PMID: 33857732 DOI: 10.1016/j.ejpn.2021.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/18/2021] [Accepted: 03/28/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Acute strabismus (AS) is the most common ocular motility disorder in children. In the emergency setting evaluation, the primary concern is to exclude a potentially dangerous underlying condition, requiring immediate intervention. Our first aim was to describe the epidemiology, clinical features, and underlying causes of AS in a cohort of children presenting to the emergency department (ED). Our second aim was to identify clinical features associated with a significant risk of underlying neurological emergencies (NEs). DESIGN AND SETTING Clinical records of all patients under 18 years presenting for AS to the ED of the Bambino Gesù Children's Hospital over a 10-year period were retrospectively reviewed. A logistic regression model was applied to detect predictive variables associated with a higher risk of NEs. RESULTS 208 patients (M:F = 1.19) were identified (0.35 cases per 1000 admission). Commonly associated symptoms included diplopia (18.3%), headache (23.1%), nausea or vomit (8.6%). Other ocular or neurological abnormalities were associated in 47.6% of patients. NEs accounted for 24.03% of all cases, mostly represented by brain tumours (8.65%). Ptosis, optic disk blurring, vomit, gait abnormalities and consciousness disorders were found to confer a significantly greater risk of an underlying NE. CONCLUSIONS Potentially severe neurological conditions may affect almost one in four children presenting to the ED for AS. Brain malignancies are the most common dangerous cause. Presence of ptosis, papilledema, vomit, gait disorders, consciousness impairment, pupillary defects and multiple cranial nerves involvement should be considered as red flags.
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Affiliation(s)
- Giacomo Garone
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Valentina Ferro
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marta Barbato
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Nicola Vanacore
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Laura Papini
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Pro
- Neurophysiology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Boni
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Barbara Scialanga
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Raffaella Nacca
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Melania Evangelisti
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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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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Meng Y, Hu X, Huang X, Zhao Y, Ye M, Yi B, Zhou L. Clinical characteristics and aetiology of acute acquired comitant esotropia. Clin Exp Optom 2021; 105:293-297. [PMID: 33926368 DOI: 10.1080/08164622.2021.1914510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CLINICAL RELEVANCE Acute acquired comitant esotropia (AACE) is characterised by the acute onset of diplopia which affects work and life.Background: To describe the clinical characteristics and discuss the aetiology of acute acquired comitant esotropia.Methods: The medical records of 51 patients with AACE were retrospectively analysed, and their age, occupation, daily average time spent on near work, angle of deviation, refractive error and aetiology were analysed.Results: The age at onset of AACE was eight to 55 years. Thirty-nine patients were aged 12 to 36 years (76.5%), and 42 patients (82.4%) were myopic. The angle of deviation was 20Δ (12Δ to 35Δ) during near fixation and 25Δ (18Δ to 40Δ) during distance fixation. The deviation during distance fixation was larger than that during near fixation, the difference being statistically significant (p < 0.001). The daily average time of near work before onset was 9.0 h (8.0 h to 10.0 h); 35 patients (68.6%) spent more than 8 h performing near work. Their occupations included students, accountants, information technology staff, and those who required electronic use for a long time. There is no correlation between the angle of deviation and the time of near work (p > 0.05). Among the 51 patients, three had intracranial diseases. Diplopia resolved in 47 cases following treatment. The angle of deviation post-treatment was 0Δ (0Δ to 5Δ) during near and 0Δ (0Δ to 3Δ) during distance fixation.Conclusion: AACE occurs mostly in myopic older children and adults. The onset of esotropia is related to long-term near work. AACE patients mostly present an angle of deviation that is larger during distance than near fixation. Intracranial disease is an infrequent but important cause of AACE that needs to be excluded in all cases.
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Affiliation(s)
- Yanfang Meng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xuemin Hu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaoqi Huang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yijia Zhao
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Meihong Ye
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Beixi Yi
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lianhong Zhou
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
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Lekskul A, Chotkajornkiat N, Wuthisiri W, Tangtammaruk P. Acute Acquired Comitant Esotropia: Etiology, Clinical Course, and Management. Clin Ophthalmol 2021; 15:1567-1572. [PMID: 33883873 PMCID: PMC8055253 DOI: 10.2147/opth.s307951] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify the etiologies, clinical course and management of acute acquired comitant esotropia in Ramathibodi Hospital, Thailand. Methods Thirty patients who were diagnosed with acute acquired comitant esotropia at Ramathibodi Hospital from January 1 2017 to December 31 2019 were identified using electronic medical records, from which demographic, etiology, clinical course and management, laboratory, and neuroimaging data were collected. Results The etiologies of acute acquired comitant esotropia were Swan (16.67%), Burian–Franceschetti (30.00%), Bielschowsky (36.67%), Arnold Chiari malformation (3.33%) and decompensated esophoria (13.33%). Mean age of onset was 19.8 ± 18.3 years. Mean angle of esodeviation was 28.4 ± 12.1 prism diopters for distance fixation and 29.3 ± 11.8 prism diopters for near fixation. Refraction differed between age groups: children under 10 years had mild hyperopia (median +0.63 diopters, first quartile +0.25 diopters, third quartile +0.75 diopters) and teenagers (10–18 years old) had emmetropia to mild myopia (median +0.25 diopters, first quartile −2.50 diopters, third quartile +0.75 diopters), whereas adults had mild to moderate myopia (median −0.75 diopters, first quartile −5.25 diopters, third quartile ±0.00 diopters). Twelve patients (40.00%) were prescribed spectacles and surgical intervention was performed in 26 patients (86.67%). All patients except one case of Arnold Chiari malformation (96.67%) maintained normal binocular function and alignment following strabismus surgery or spectacles correction. Conclusion Bielschowsky was the most common etiology of acute acquired comitant esotropia in our study. We suggest that refraction should be performed in all patients with acute acquired comitant esotropia. Most etiologies were benign and might not require neuroimaging. However, neuroimaging is recommended in those with atypical presentations, such as nystagmus, headache, or cerebellar signs. Surgical intervention with a 0.5–1.0 mm increase in recession was effective for restoring ocular alignment and binocular function in our patients.
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Affiliation(s)
- Apatsa Lekskul
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Wadakarn Wuthisiri
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Roda M, Pellegrini M, Rosti A, Fresina M, Schiavi C. Augmented bimedial rectus muscles recession in acute acquired concomitant esotropia associated with myopia. Can J Ophthalmol 2020; 56:166-170. [PMID: 33160920 DOI: 10.1016/j.jcjo.2020.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/30/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review the clinical features of acute acquired concomitant esotropia in myopia and the results of augmented bilateral symmetrical medial rectus recession. METHODS The medical charts of 50 patients diagnosed with acute acquired concomitant esotropia associated with myopia between 2013 and 2018 were reviewed. The dose-response was calculated, and the relationship of sex, age, refraction, best-corrected visual acuity (BCVA), preoperative deviation angle, and stereopsis with surgical results were analysed. RESULTS Forty-six patients (mean age 40.1 ± 18.1 years) were included in the study. Preoperative esotropia angle at near and distance were, respectively, 26.0 ± 7.5 PD and 25.2 ± 7.9 PD. Surgery amount was 12.1 ± 1.8 mm of recession, and surgical success was achieved in 38 patients (82.6%). No overcorrections were recorded. At 1-year follow-up, the mean deviation angle at distance and at near was 1.9 ± 2.4 and 1.7 ± 2.1 PD, and no recurrences were observed. The average dose-response was 1.8 ± 0.6 PD/mm and was positively correlated with preoperative angle of deviation (R2 = 0.799, p < 0.001) and negatively correlated with age (R2 = -0.365, p = 0.013). Conversely, there were no significant associations between dose-response and sex, refractive error, BCVA, or stereopsis (all p > 0.05). Factors associated with surgical failure were a lower amount of recession and absence of stereopsis. CONCLUSIONS Augmented bilateral medial rectus recession allows good motor and sensory results in patients with acute acquired concomitant esotropia associated with myopia.
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Affiliation(s)
- Matilde Roda
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.
| | - Marco Pellegrini
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Rosti
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Michela Fresina
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Costantino Schiavi
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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Vagge A, Giannaccare G, Scarinci F, Cacciamani A, Pellegrini M, Bernabei F, Scorcia V, Traverso CE, Bruzzichessi D. Acute Acquired Concomitant Esotropia From Excessive Application of Near Vision During the COVID-19 Lockdown. J Pediatr Ophthalmol Strabismus 2020; 57:e88-e91. [PMID: 33090234 DOI: 10.3928/01913913-20200828-01] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022]
Abstract
The public health measures imposed in many countries to slow the spread of the novel coronavirus (COVID-19) outbreak could have negative effects on children's physical and mental health. The authors describe four cases of acquired concomitant acute esotropia likely caused from excessive application of near vision during the COVID-19 lockdown. [J Pediatr Ophthalmol Strabismus. 2020;57:e88-e91.].
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Ruatta C, Schiavi C. Acute acquired concomitant esotropia associated with myopia: is the condition related to any binocular function failure? Graefes Arch Clin Exp Ophthalmol 2020; 258:2509-2515. [DOI: 10.1007/s00417-020-04818-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/17/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022] Open
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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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Heavy eye syndrome: Myopia-induced strabismus. Surv Ophthalmol 2020; 66:138-144. [PMID: 32522490 DOI: 10.1016/j.survophthal.2020.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/20/2020] [Accepted: 06/01/2020] [Indexed: 11/22/2022]
Abstract
Heavy eye syndrome is an important type of myopia-induced strabismus. We provide an overview of heavy eye syndrome, from its history to its most salient features. The theory of the orbital and rectus muscle pulley system as it relates to heavy eye syndrome and the prevailing theories on the pathophysiology of heavy eye syndrome in the current literature are discussed. We also highlight the presentation of heavy eye syndrome, its typical features on imaging, and differential diagnosis. Finally, we provide an overview on the management of heavy eye syndrome, including a description of several current surgical techniques.
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Gazulla J, Orduna-Hospital E, Benavente I, Rodríguez-Valle A, Osorio-Caicedo P, Alvarez-de Andrés S, García-González E, Fraile-Rodrigo J, Fernández-Tirado FJ, Berciano J. Contributions to the study of spinocerebellar ataxia type 38 (SCA38). J Neurol 2020; 267:2288-2295. [PMID: 32314013 DOI: 10.1007/s00415-020-09840-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report clinical and ancillary findings in a kindred with spinocerebellar ataxia 38 (SCA38). PATIENTS AND METHODS Five family members spanning two generations developed gait ataxia and intermittent diplopia. On examination, a cerebellar syndrome accompanied by downbeat nystagmus and a saccadic head impulse test (HIT) were found. RESULTS Whole-exome sequencing demonstrated a heterozygous variant in ELOVL5, c.779A > G (p.Tyr260Cys), in four tested patients. Intermittent concomitant esotropia and hypertropia caused transient diplopia in one individual each. Saccadic HIT responses were found in four subjects. Sensorineural hypoacusis was present in every case. Electrophysiological studies demonstrated a sensory neuronopathy in patients from the first generation, with prolonged disease duration. Baseline serum docosahexaenoic acid (DHA) percent was diminished in four individuals. Oral 26-week dietary DHA supplementation, 650 mg/day, raised serum DHA percent and induced a statistically significant reduction in Scale for the Assessment and Rating of Ataxia (SARA) total scores, and in stance and heel-shin slide item scores. CONCLUSION The mentioned ELOVL5 variant segregated with disease in this kindred. Downbeat nystagmus, intermittent heterotropia causing transient diplopia, vestibular impairment demonstrated by abnormal HIT, and sensory neuronopathy were part of the clinical picture in this series. DHA supplementation raised serum DHA percent in cases with diminished levels, and induced a clinical amelioration and a statistically significant reduction in SARA scores in the study group. Further studies are needed to investigate the role of these findings in SCA38, and to determine the response to prolonged DHA supplementation.
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Affiliation(s)
- José Gazulla
- Department of Neurology, Hospital Universitario Miguel Servet, Isabel la Católica 1-3, 50009, Zaragoza, Spain.
| | | | - Isabel Benavente
- Department of Clinical Neurophysiology, Hospital San Jorge, Huesca, Spain
| | - Ana Rodríguez-Valle
- Section of Genetics, Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Pedro Osorio-Caicedo
- Department of Clinical Neurophysiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Elena García-González
- Department of Clinical Biochemistry, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jesús Fraile-Rodrigo
- Department of Otolaryngology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - José Berciano
- Department of Neurology, CIBERNED, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria, Santander, Spain
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Chang F, Wang T, Yu J, Li M, Lu N, Chen X. Prism treatment of acute acquired concomitant esotropia precipitated by visual confusion. Strabismus 2020; 28:7-12. [PMID: 32301677 DOI: 10.1080/09273972.2020.1717552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Feng Chang
- Department of Ophthalmology, General Hospital of Central Theater Command of People’s Liberation Army of China, Wuhan, Hubei
| | - Tao Wang
- Department of Ophthalmology, General Hospital of Central Theater Command of People’s Liberation Army of China, Wuhan, Hubei
| | - Juan Yu
- Department of Ophthalmology, General Hospital of Central Theater Command of People’s Liberation Army of China, Wuhan, Hubei
| | - Mei Li
- Department of Ophthalmology, General Hospital of Central Theater Command of People’s Liberation Army of China, Wuhan, Hubei
| | - Ning Lu
- Department of Ophthalmology, General Hospital of Central Theater Command of People’s Liberation Army of China, Wuhan, Hubei
| | - Xiao Chen
- Department of Ophthalmology, General Hospital of Central Theater Command of People’s Liberation Army of China, Wuhan, Hubei
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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: 11] [Impact Index Per Article: 2.2] [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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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] [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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García-Basterra I, Rodríguez Del Valle JM, García-Ben A, Rodríguez Sánchez JM, García-Campos JM. Outcomes of Medial Rectus Recession With Adjustable Suture in Acute Concomitant Esotropia of Adulthood. J Pediatr Ophthalmol Strabismus 2019; 56:101-106. [PMID: 30889264 DOI: 10.3928/01913913-20190206-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 12/31/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To review and analyze the surgical outcomes of bilateral medial rectus recession with adjustable suture in acute concomitant esotropia of adulthood (ACEA). METHODS The charts of all adults diagnosed as having ACEA between 2004 and 2017 were reviewed. Best corrected visual acuity, refractive error, ocular alignment measured in prism diopters (PD), and stereopsis were examined at presentation, 1 day postoperatively, and final follow-up visit (median: 10 months; range: 4 to 144 months). All patients underwent bilateral medial rectus recession using adjustable suture surgery and topical anesthesia. Statistical analysis was used to calculate surgical dose-responses and to study possible correlations with clinical parameters. RESULTS Fifteen patients diagnosed as having ACEA were included. The mean age was 39.2 ± 10.7 years, and the mean refractive errors in the right and left eyes were -3.97 ± 2.87 and -3.60 ± 2.74 diopters (D), respectively. Average esotropia deviations at near and distance were 22.7 ± 7.2 and 23.0 ± 7.5 PD. All patients improved with medial rectus recession (mean: 12.0 ± 2.2 mm) with a final mean deviation of 0.7 ± 1.8 PD. The mean dose-responses at 1 day postoperatively and final visit were 1.86 ± 0.58 and 1.83 ± 0.43 PD/mm, respectively. There was a significant positive correlation between surgical dose-responses at 1 day postoperatively and final visit and preoperative deviation (R2 = 0.55; P < .001; R2 = 0.66; P < .001), whereas there were no significant correlations with age, sex, refractive error, BCVA, or stereopsis (all P > .05). CONCLUSIONS Good postoperative and final outcomes are achieved with large medial rectus recessions in ACEA. A larger dose-response can be expected in large preoperative deviations, independent of other clinical and ocular parameters. [J Pediatr Ophthalmol Strabismus. 2019;56(2):101-106.].
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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: 12] [Impact Index Per Article: 2.0] [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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Decompensated Esophoria as a Benign Cause of Acquired Esotropia. Am J Ophthalmol 2018; 194:95-100. [PMID: 30053478 DOI: 10.1016/j.ajo.2018.07.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine informative clinical and magnetic resonance imaging (MRI) characteristics of patients with symptomatic adult acquired, comitant esotropia due to decompensated esophoria. DESIGN Retrospective, interventional case series. METHODS Setting: Institutional. STUDY POPULATION Patients with decompensated esophoria who developed acute acquired comitant esotropia. OBSERVATION PROCEDURES Ophthalmic examination, stereopsis, and strabismus measurements at distance and near using prism cover tests in diagnostic gaze positions were performed. Patients underwent high-resolution surface coil MRI of extraocular muscles with target fixation, and MRI of the brain. Strabismus surgery was performed under topical anesthesia with adjustable sutures wherever possible. Paired t testing was used to evaluate postoperative changes with 0.05 considered significant. MAIN OUTCOME MEASURE Clinical and MRI characteristics, and surgical outcome of patients with decompensated esophoria. RESULTS Eight cases were identified involving subjects of mean age 29 ± 9.4 (range: 20-48) years having gradually progressive intermittent horizontal, binocular diplopia for 10 months to 3 years. Mean preoperative esotropia was 31 ± 12 Δ at distance and 29 ± 12 Δ at near, although this was intermittent in 5 patients who exhibited enhanced fusional divergence. Neurologic evaluation and MRI of brain, orbits, and extraocular muscles were unremarkable in all cases. Orthotropia was successfully restored in all by standard or enhanced doses of bimedial rectus muscle recession surgery, improving mean stereoacuity from 535 to 68 arc seconds, although 5 patients exhibited 2-14 Δ asymptomatic residual esophoria. CONCLUSION Decompensated esophoria is a benign clinical entity causing acute, acquired, comitant esotropia treatable with enhanced medial rectus recession.
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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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Fu T, Wang J, Levin M, Xi P, Li D, Li J. Clinical features of acute acquired comitant esotropia in the Chinese populations. Medicine (Baltimore) 2017; 96:e8528. [PMID: 29145257 PMCID: PMC5704802 DOI: 10.1097/md.0000000000008528] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Acute acquired comitant esotropia (AACE) is an unusual presentation of esotropia that occurs after infancy. This study was aimed to study the clinical features and the differences between children and adult patients with AACE in the Chinese populations.This was a retrospective analysis of patients diagnosed with AACE over 4 years; 69 patients (25 females and 44 males) were identified. The patients were divided into 3 groups: < 10 year-old (n = 6, 8.7%), 10-18 year-old (n = 23, 33.3%), and ≥18 year-old (n = 40, 58.0%). Patients underwent medical history, brain and orbital computed tomography, and ophthalmological and orthoptic examinations.The refractions of AACE patients varied among age groups: patients < 10 year-old had mild hypermetropia, while older children and adults showed moderate-to-high myopia (P < .001). The mean angles of esotropia were significantly larger in young children compared with older children and adults (P = .005). There was no significant difference in binocularity detected by either synoptophore or TNO stereoscopic testing among different disease durations. Stereopsis detected by synoptophore and TNO testing showed no significant difference at duration within half a year, but the stereopsis measured by TNO was significantly worse than that detected by synoptophore with extending disease duration (P < .05).AACE seems to occur mostly in older children and adults in the Chinese population. Younger children with AACE seem to demonstrate a common trait of mild hypermetropic refractive errors, while myopia can be seen in older children and adult patients. The duration from onset to treatment of esotropia does not affect the preoperative binocularity.
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Affiliation(s)
- Tao Fu
- aBeijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China bUniversity of Maryland Medical Center, Baltimore, MD cDepartment of Neurobiology and Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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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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Erkan Turan K, Kansu T. Acute Acquired Comitant Esotropia in Adults: Is It Neurologic or Not? J Ophthalmol 2016; 2016:2856128. [PMID: 28018672 PMCID: PMC5149673 DOI: 10.1155/2016/2856128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/24/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives. Acute acquired comitant esotropia (AACE) can be a diagnostic challenge for ophthalmologists and neurologists because of its association with neurological pathologies. Our study describes a series of adult patients with AACE of undetermined etiology. Methods. Data on the clinical findings of patients presented with AACE of undetermined etiology with a minimum follow-up of 1 year were retrieved from the medical records and the results analyzed. Results. A series of 9 esotropia cases (age range: 20-43 years) was reviewed. All patients had full duction and versions, without an A-pattern or V-pattern. All patients had esotropia for distance and near. Neurological evaluation in all cases was normal. Among patients, 3 were treated with prisms, 4 were treated with strabismus surgery, and 1 was treated with botulinum toxin injections; 1 patient declined treatment. In treated patients posttreatment sensory testing indicated restoration of binocularity that remained stable throughout follow-up of 1-9 years. The patient that declined treatment had binocular function with base-out prisms. Conclusion. Acute onset esotropia may be seen without a neurological pathology in adults. Good motor and sensory outcomes can be achieved in these patients with AACE of undetermined etiology via surgical and nonsurgical methods.
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Affiliation(s)
- Kadriye Erkan Turan
- Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tulay Kansu
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Abstract
Disrupting binocular vision in infancy leads to strabismus and oftentimes to a variety of associated visual sensory deficits and oculomotor abnormalities. Investigation of this disorder has been aided by the development of various animal models, each of which has advantages and disadvantages. In comparison to studies of binocular visual responses in cortical structures, investigations of neural oculomotor structures that mediate the misalignment and abnormalities of eye movements have been more recent, and these studies have shown that different brain areas are intimately involved in driving several aspects of the strabismic condition, including horizontal misalignment, dissociated deviations, A and V patterns of strabismus, disconjugate eye movements, nystagmus, and fixation switch. The responses of cells in visual and oculomotor areas that potentially drive the sensory deficits and also eye alignment and eye movement abnormalities follow a general theme of disrupted calibration, lower sensitivity, and poorer specificity compared with the normally developed visual oculomotor system.
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Affiliation(s)
- Vallabh E Das
- College of Optometry, University of Houston, Houston, Texas 77204;
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Gilbert AL, Koo EB, Heidary G. Evaluation and Management of Acute Acquired Comitant Esotropia in Children. Semin Ophthalmol 2016; 32:8-13. [DOI: 10.1080/08820538.2016.1228398] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Aubrey L. Gilbert
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, and Massachusetts Eye & Ear Infirmary, Boston, MA, USA
| | - Euna B. Koo
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, and Massachusetts Eye & Ear Infirmary, Boston, MA, USA
| | - Gena Heidary
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, and Massachusetts Eye & Ear Infirmary, Boston, MA, USA
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Lee HS, Park SW, Heo H. Acute acquired comitant esotropia related to excessive Smartphone use. BMC Ophthalmol 2016; 16:37. [PMID: 27061181 PMCID: PMC4826517 DOI: 10.1186/s12886-016-0213-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 03/31/2016] [Indexed: 11/10/2022] Open
Abstract
Background To describe the clinical characteristics and outcomes of acute acquired comitant esotropia (AACE) related to excessive smartphone use in adolescents. Methods The medical records of 12 patients with AACE and a history of excessive smartphone use were retrospectively reviewed, and the duration of smartphone use, angle of deviation, refractive error, stereopsis, and treatment options were analyzed. Results All patients showed convergent and comitant esotropia ranging from 15 to 45 prism diopters (PD; average: 27.75 ± 11.47 PD) at far fixation. The angle of deviation was nearly equivalent for far and near fixation. Every patient used a smartphone for more than 4 h a day over a period of several months (minimum 4 months). Myopic refractive errors were detected in eight patients (average:−3.84 ± 1.68 diopters (D]), and the remaining four patients showed mild hyperopic refractive error (average: +0.84 ± 0.53 D). Reductions in esodeviation were noted in all patients after refraining from smartphone use, and bilateral medial rectus recession was performed in three patients with considerable remnant esodeviation. Postoperative exams showed orthophoria with good stereoacuity in these patients. Conclusion Excessive smartphone use might influence AACE development in adolescents. Refraining from smartphone use can decrease the degree of esodeviation in these patients, and remnant deviation can be successfully managed with surgical correction.
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Affiliation(s)
- Hyo Seok Lee
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwang-Ju, 61469, South Korea
| | - Sang Woo Park
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwang-Ju, 61469, South Korea
| | - Hwan Heo
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwang-Ju, 61469, South Korea.
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