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Rachid E, Mansour H, Ibrahim P, Al-Haddad C, Haddad R, Hassan SA, Bou Ghannam A. Modified partial Jensen procedure to treat a hypertropic Knobby eye syndrome in a high myopic monocular patient. Eur J Ophthalmol 2024; 34:NP8-NP12. [PMID: 37671437 DOI: 10.1177/11206721231200142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
We present a case of severe esotropia and hypertropia in a monocular high myope with an inferolateral staphyloma. Surgery was undertaken to secure the inferior rectus to the lateral rectus via a modified partial Jensen technique, along with medial rectus recession successfully improving head and eye positions and ductions.
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Affiliation(s)
- Elza Rachid
- Ophthalmology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hana Mansour
- Ophthalmology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Perla Ibrahim
- Ophthalmology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christiane Al-Haddad
- Ophthalmology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Randa Haddad
- Ophthalmology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Al Hassan
- Ophthalmology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alaa Bou Ghannam
- Ophthalmology Department, American University of Beirut Medical Center, Beirut, Lebanon
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Zimmermann-Paiz MA. A patient with congenitally restrictive strabismus and contralateral secondary muscle enlargement. Eur J Ophthalmol 2024; 34:NP5-NP7. [PMID: 37644840 DOI: 10.1177/11206721231198885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
AIM To report the case of a congenital restrictive strabismus with a contralateral enlargement of extraocular muscles. CASE The clinical presentation, findings, and postoperative outcomes of a 4 years old boy referred to evaluation for presenting a left eye deviation since birth are detailed. CONCLUSION A unilateral congenital restrictive strabismus (congenital hypotropia and esotropia) can be the cause of contralateral secondary enlarged extraocular muscle and It must be included in the differential diagnosis.
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Affiliation(s)
- Martin A Zimmermann-Paiz
- Departamento de Oftalmología, Hospital de Accidentes "Ceibal", Instituto Guatemalteco de Seguridad Social, Guatemala, Guatemala C.A
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Nouraeinejad A. Neurological pathologies in acute acquired comitant esotropia. Graefes Arch Clin Exp Ophthalmol 2023; 261:3347-3354. [PMID: 37145335 PMCID: PMC10161163 DOI: 10.1007/s00417-023-06092-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/16/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Acute acquired comitant esotropia (AACE) is an uncommon subtype of esotropia characterized by sudden and usually late onset of a relatively large angle of comitant esotropia with diplopia in older children and adults. METHODS A literature survey regarding neurological pathologies in AACE was conducted using databases (PubMed, MEDLINE, EMBASE, BioMed Central, the Cochrane Library, and Web of Science) in order to collect data for a narrative review of published reports and available literature. RESULTS The results of the literature survey were analyzed to provide an overview of the current knowledge of neurological pathologies in AACE. The results revealed that AACE with unclear etiologies can occur in many cases in both children and adults. Functional etiological factors for AACE were found to be due to many reasons, such as functional accommodative spasm, the excessive near work use of mobile phones/smartphones, and other digital screens. In addition, AACE was found to be associated with neurological disorders, such as astrocytoma of the corpus callosum, medulloblastoma, tumors of the brain stem or cerebellum, Arnold-Chiari malformation, cerebellar astrocytoma, Chiari 1 malformation, idiopathic intracranial hypertension, pontine glioma, cerebellar ataxia, thalamic lesions, myasthenia gravis, certain types of seizures, and hydrocephalus. CONCLUSIONS Previously reported cases of AACE with unknown etiologies have been reported in both children and adults. However, AACE can be associated with neurological disorders that require neuroimaging probes. The author recommends that clinicians should perform comprehensive neurological assessments to rule out neurological pathologies in AACE, especially in the presence of nystagmus or abnormal ocular and neurological indications (e.g., headache, cerebellar imbalance, weakness, nystagmus, papilloedema, clumsiness, and poor motor coordination).
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Affiliation(s)
- Ali Nouraeinejad
- Department of Clinical Ophthalmology, University College London (UCL), London, United Kingdom.
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Zou L, Wang D, Zhang J, Chen L, Wang S, Liu H. Esotropia-hypertropia complex in a patient with myopic strabismus fixus. J AAPOS 2023; 27:372-374. [PMID: 37777052 DOI: 10.1016/j.jaapos.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/27/2023] [Accepted: 08/09/2023] [Indexed: 10/02/2023]
Abstract
Patients with highly myopic strabismus generally develop esotropia and hypotropia. We report the case of a 54-year-old woman with a combination of esotropia-hypertropia complex in the right eye and esotropia-hypotropia complex in the left eye, with unilateral congenital severe ptosis. The patient had inferotemporal prolapse of the globe in the right eye. Inferotemporal prolapse in this case could have been due to extraocular muscle pulley dehiscence in this area, causing the inferior oblique muscle to slip around the globe along the path of least resistance. Subsequently, the inferotemporal staphyloma would have prevented the typical esotropia and hypotropia of the globe.
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Affiliation(s)
- Leilei Zou
- Department of Ophthalmology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dan Wang
- Bright Eye Hospital, Shanghai, China
| | - Ju Zhang
- Bright Eye Hospital, Shanghai, China
| | - Li Chen
- Bright Eye Hospital, Shanghai, China; Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu Wang
- Department of Ophthalmology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Hong Liu
- Department of Ophthalmology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Bright Eye Hospital, Shanghai, China.
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Senda J, Hirao R, Maeda K, Amakusa Y, Hirunagi T, Katsuno M, Kawaguchi K. Acute bilateral hypotropia and esotropia complex as first manifestation of multiple sclerosis: a case report. Nagoya J Med Sci 2023; 85:822-827. [PMID: 38155615 PMCID: PMC10751496 DOI: 10.18999/nagjms.85.4.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/30/2022] [Indexed: 12/30/2023]
Abstract
A 21-year-old Japanese woman presented with sudden eye movement disorders. An ophthalmic examination revealed bilateral hypotropia and esotropia complex. Brain magnetic resonance imaging revealed abnormal signals in the posterior and medial part of the lower pontine tegmentum (including periventricular and subcortical white matter) that were suggestive of demyelination. A cerebrospinal fluid test was positive for oligoclonal bands. She was subsequently diagnosed with multiple sclerosis and was administered intravenous methylprednisolone and oral dimethyl fumarate, with complete recovery from hypotropia and esotropia after two months. Bilateral hypotropia and esotropia are important clinical signs for the accurate diagnosis of multiple sclerosis.
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Affiliation(s)
- Joe Senda
- Department of Neurology and Rehabilitation, Komaki City Hospital, Komaki, Japan
| | - Ryota Hirao
- Department of General Internal Medicine, Komaki City Hospital, Komaki, Japan
| | - Kentaro Maeda
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinobu Amakusa
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Hirunagi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsuhiro Kawaguchi
- Department of General Internal Medicine, Komaki City Hospital, Komaki, Japan
- Department of Cardiology, Komaki City Hospital, Komaki, Japan
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MacKinnon JR, McCulloch J. Comment on: Clinical characteristics and risk factors of acute acquired concomitant esotropia in last 5 years: a retrospective case-control study. Eye (Lond) 2023; 37:3296. [PMID: 36928223 PMCID: PMC10018579 DOI: 10.1038/s41433-023-02501-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/07/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Affiliation(s)
- Jane R MacKinnon
- Ophthalmology Department, Raigmore Hospital, Inverness, IV2 3UJ, Scotland, UK.
| | - Jean McCulloch
- Ophthalmology Department, Raigmore Hospital, Inverness, IV2 3UJ, Scotland, UK
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Rosenbaum ARP, Jewell JL, Searns JB. Infant with Acute Onset Esotropia. Pediatr Rev 2023; 44:S55-S58. [PMID: 37777233 DOI: 10.1542/pir.2021-005330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
| | - Jerry L Jewell
- Department of Pediatrics
- Department of Neurology, University of Colorado, Aurora, CO
| | - Justin B Searns
- Department of Pediatrics
- Division of Hospital Medicine; Division of Infectious Diseases, Department of Pediatrics, University of Colorado, Aurora, CO
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Agrawal A, Geh V. 14 Surgical treatment of heavy eye syndrome by modified loop myopexy. BMJ Open Ophthalmol 2023; 8:A5. [PMID: 37797985 DOI: 10.1136/bmjophth-2023-biposa.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Heavy eye syndrome or convergent strabismus fixus is an acquired strabismus typically seen in eyes with high myopia. We present a case, discuss the aetiology and management, and include a short video illustrating the surgical procedure undertaken.A 47-year-old highly myopic woman with h/o bilateral cataract surgery and B/L scleral buckling for retinal detachments, had left esotropia and hypotropia measuring more than 40 prism dioptres base-out and 12 prism dioptres base up. MRI orbits showed bilateral asymmetrical medial deviation of ocular bulbs, more on left side. Also, there was degeneration of lateral rectus-superior rectus band with displacement of lateral rectus downwards.She underwent Botox to bi-medial recti after which she could demonstrate potential for binocular single vision. A left un-augmented loop Myopexy procedure and recession of the left medial rectus was thereafter performed under general anaesthesia. After surgery, her eyes were binocularly aligned for near with minimal esotropia for distance.This case suggests that patients with significant esotropia combined with high myopia should be suspected to have heavy eye syndrome. Orbital imaging should be undertaken to demonstrate the anatomical abnormality and muscle paths to confirm a definite diagnosis. Modified Loop Myopexy was found to be effective in this case of heavy eye syndrome.
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Affiliation(s)
- A Agrawal
- Southend University Hospital, Mid and South Essex Foundation NHS Trust, UK
| | - Vsy Geh
- Southend University Hospital, Mid and South Essex Foundation NHS Trust, UK
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Pujara P, Carter D, Bolton K, Nicholson R. 20 Simultaneous development of acute acquired concomitant esotropia in two siblings during the COVID-19 pandemic: a case report. BMJ Open Ophthalmol 2023; 8:A7. [PMID: 37798005 DOI: 10.1136/bmjophth-2023-biposa.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
A 5-year-old boy (sibling one) and his 11-year-old sister (sibling two) 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.Sibling one had a moderate right esotropia, initially maintained straight by corneal light reflex. He measured 45/50 prism dioptres (Δ) base out at near and 45Δ base out at distance. Sibling two had esophoria which broke down into a right esotropia immediately on dissociation. The esotropia measured 30Δ base out at near and 20Δ base out at distance. At four month follow up, both siblings demonstrated a constant large angle esotropia (sibling one: 54Δ base out at near and 45Δ base out at distance, sibling two: 45Δ base out at near and 40/45Δ base out at distance).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.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)
- P Pujara
- Portsmouth University Hospitals NHS Trust, UK
| | - D Carter
- Portsmouth University Hospitals NHS Trust, UK
| | - K Bolton
- Portsmouth University Hospitals NHS Trust, UK
| | - R Nicholson
- Portsmouth University Hospitals NHS Trust, UK
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Hou P, Liu L, Yang G. An atypical case of myopic strabismus fixus. J AAPOS 2023; 27:231-233. [PMID: 37348674 DOI: 10.1016/j.jaapos.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 06/24/2023]
Abstract
We present an atypical case of progressive fixed hypertropia in a patient with extreme myopia. Myopic strabismus fixus is typically characterized by progressive esotropia and hypotropia, which is caused by the protrusion of the posterior eyeball from the superotemporal quadrant of the extraocular muscle cone. In this case, the patient's right eye was fixed in a superomedial position, and the left eye was fixed and deviated upward. Magnetic resonance imaging revealed protrusion of a posterior scleral staphyloma inferotemporally in each eye. This case illustrates how the pattern of strabismus fixus caused by high myopia depends on the direction of the protrusion of the posterior pole and the resulting displacement of extraocular muscle paths.
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Affiliation(s)
- Peixian Hou
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Longqian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guoyuan Yang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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11
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Gim Y, Jung JH. Extraocular muscle enlargement of indeterminate cause in pediatric patients: case series and literature review. J AAPOS 2023; 27:205.e1-205.e6. [PMID: 37429539 DOI: 10.1016/j.jaapos.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 04/17/2023] [Accepted: 06/07/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE To specify the clinical characteristics of enlarged extraocular muscles of indeterminate cause in pediatric patients based on a case series and literature review. METHODS The medical records of pediatric patients who presented between January 2019 and January 2022 with enlarged extraocular muscles, where the underlying cause could not be determined, were retrospectively reviewed. RESULTS Four patients were included. The main reason for presentation was evaluation of abnormal head posture. Head tilt or turn with duction deficit was observed in all patients. The age of onset ranged from 6 months to 1 year. Two patients presented with esotropia and hypotropia; the other 2 patients, with large-angle esotropia. Orbital imaging was performed in all cases and revealed unilateral rectus muscle enlargement sparing the muscle tendon. All 4 patients were found to have an enlarged medial rectus muscle. In the 2 patients with hypotropia, the inferior rectus muscle was also involved. No underlying systemic or orbital disease was found. There were no changes in the orbit or extraocular muscles on follow-up imaging test. The intraoperative forced duction test revealed severe restriction in the direction of gaze opposite to the primary field of action of the enlarged muscles. CONCLUSIONS Enlargement of extraocular muscles should be considered in the differential diagnosis when large-angle incomitant vertical or horizontal misalignment and abnormal head posture are observed in infancy.
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Affiliation(s)
- Yujin Gim
- Department of Ophthalmology, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea; Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
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12
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Marchione G, Lambert SR. Inferior rectus transposition as a secondary surgery in patients with acquired abducens nerve palsy. J AAPOS 2023; 27:170-172. [PMID: 37054964 PMCID: PMC10330143 DOI: 10.1016/j.jaapos.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 04/15/2023]
Abstract
We report the outcomes in 2 patients with acquired abducens nerve palsy with residual esotropia following superior rectus transposition and medial rectus recession who subsequently underwent inferior rectus transposition as a second procedure. Both patients showed improved abduction and reduced esotropia, with no induced cyclotorsion or vertical deviation. Inferior rectus transposition as a secondary procedure in these 2 patients with abducens nerve palsy appeared to augment the effect of prior superior rectus transposition and medial rectus recession.
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Affiliation(s)
- Giulia Marchione
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
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Farvardin H, Ahmadifar A, Farvardin H, Farvardin M. Long-term results of strabismus surgery for treatment of esotropia in patients with Möbius syndrome. J AAPOS 2023; 27:149.e1-149.e5. [PMID: 37182652 DOI: 10.1016/j.jaapos.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE To evaluate the surgical results of Möbius syndrome esotropia following bilateral medial rectus recession with and without bilateral Hummelsheim procedure. METHODS The medical records of patients with Möbius syndrome operated on by a single surgeon from 1993 to 2022 were studied retrospectively. For each patient, age, sex, and ocular deviation before and after surgery were retrieved. Success was defined as a horizontal deviation of up to 15Δ and vertical deviation of <10Δ. RESULTS Eleven patients were included. Average patient age at the time of surgery was 4 years. Eight patients with esodeviation up to 70Δ underwent bilateral medial rectus recession; 3 patients with esotropia >70Δ underwent recession plus bilateral Hummelsheim procedure. The mean esodeviation before surgery was 52.5Δ in the first group and 86.6Δ in the second group. The mean horizontal deviation at early follow-up was esotropia of 7.4Δ in the first group and of 15Δ in the second group. The early success rate was 87% in the first group and 67% in the second group. Long-term follow-up revealed exoshift in 43% of the patients in the first group and all 3 patients in the second group. CONCLUSIONS In our small patient cohort of patients with Möbius syndrome, bilateral medial rectus recession corrected esodeviations of up to 70Δ. In more severe cases (>70Δ), adding bilateral Hummelsheim procedure was beneficial.
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Affiliation(s)
- Hajar Farvardin
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ahmadifar
- Department of Orthopedics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Farvardin
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Farvardin
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [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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Hernandez-García E, Burgos-Blasco B, Özkan SB, Sharma P, Aguilar Ruiz A, Dominguez DP, Lai YH, Carreño Cevallos D, Molinari A, Gómez-de-Liaño R. A comparative multicentric long-term study of un-augmented modified Nishida procedure vs augmentation in unilateral sixth nerve palsy. Eye (Lond) 2023; 37:170-175. [PMID: 35067684 PMCID: PMC9829711 DOI: 10.1038/s41433-021-01917-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 11/30/2021] [Accepted: 12/20/2021] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To compare the effectiveness of three procedures: modified Nishida procedure alone vs modified Nishida procedure combined with medial rectus recession (MRc) vs modified Nishida procedure combined with MRc and botulinum toxin (BT) for severe unilateral sixth nerve palsy. DESIGN Consecutive, interventional case series. METHODS The medical records of a consecutive series of patients with severe unilateral sixth nerve palsy who underwent modified Nishida procedure in multiple centres were reviewed. Surgical technique was decided preoperatively at the surgeon's discretion. The preoperative and postoperative findings were compared. RESULTS Of the 43 patients with abducens palsy that received the procedure, 32 were included (mean age 38.6 ± 19.8 years). Mean preoperative deviation was 63.0 ± 27.3 prism dioptres (PD) and mean limitation of abduction -4.5 ± 1.2. Five patients underwent a modified Nishida procedure alone, 24 patients had an additional MRc and 3 patients were also injected with BT. Overall, the average correction of modified Nishida technique by itself was 29.4 ± 6.6 PD (range 20-36) and adding a MRc corrected 62.6 ± 23.8 PD (range 24-120). Modified Nishida procedure, MRc and BT altogether corrected 95.0 ± 18.0 PD (range 75-110). No postoperative complications were observed in any of the patients. CONCLUSIONS Excellent outcomes with fewer complications are obtained with modified Nishida procedure alone. The need for additional procedures such as MRc and BT which increase the effect in primary position can be determined depending on passive duction and preoperative horizontal deviation.
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Affiliation(s)
- Elena Hernandez-García
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Barbara Burgos-Blasco
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | | | - Pradeep Sharma
- Section of Strabismus, Pediatric Ophthalmology and Neuroophthalmology, RP Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Alejandra Aguilar Ruiz
- Departamento de Estrabismo, Instituto de Oftalmología Fundacion Conde de Valenciana, Ciudad de Mexico, Mexico
| | - Daniel P Dominguez
- Servicio de Oftalmología, Hospital Parmenio Piñero, Buenos Aires, Argentina
| | - Yu-Hung Lai
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | | | - Andrea Molinari
- Departamento de Oftalmología, Hospital Metropolitano, Quito, Ecuador
| | - Rosario Gómez-de-Liaño
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Mejía G, Guevara S, Salgado Y, Tello A. SEVERE NEAR REFLEX SPASM IN A HEALTHY TEENAGER. A CASE REPORT. Cesk Slov Oftalmol 2023; 79:97-100. [PMID: 37072257 DOI: 10.31348/2023/15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Spasm of the near reflex usually includes accommodative spasm, esophoria/tropia, and different degrees of miosis. Patients usually refer to distance blurred and fluctuating vision, ocular discomfort, and headaches. The diagnosis is established with refraction with and without cycloplegia; most of the cases have a functional etiology. However, some cases require neurological conditions to be ruled out; cycloplegics have an important diagnostic and therapeutic role. PURPOSE To describe a case of bilateral severe accommodative spasm in a healthy 14-year-old teenager. CASE PRESENTATION A 14-year-old boy with progressive diminished visual acuity attended for YSP consultation. The diagnosis of bilateral spasm of the near reflex was made, based on a gap refraction of 9.75 D between retinoscopy with and without cycloplegia and esophoria with normal keratometry and axial length. The spasm was eliminated with 2 drops of cycloplegic in each eye separated by 15 days; no clear etiology was found other than the start of school. CONCLUSION Clinicians should be aware of pseudomyopia, especially in children with acute changes in visual acuity, who are usually exposed to myopigenic environmental factors that induce overstimulation of the parasympathetic third cranial nerve's innervation.
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Nakao S, Miyata M, Hirai M, Mizoguchi S, Ohashi H, Nishiwaki H. Rescue of exotropia subsequent to pulled-in-two syndrome of the medial rectus muscle occurring during surgery for high myopic strabismus fixus: A case report. Medicine (Baltimore) 2022; 101:e31864. [PMID: 36596031 PMCID: PMC9803451 DOI: 10.1097/md.0000000000031864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Pulled-in-two syndrome is one of the significant complications of strabismus surgery. This study aimed to report a case of pulled-in-two syndrome of the contractured medial rectus muscle (MR) that occurred during strabismus surgery for strabismus fixus due to high myopia, and to describe a rescue of this complication. PATIENT CONCERNS A woman in her 60s presented to our Ophthalmology Department with the main complaint of unilateral high myopia and severe myopic strabismus fixus. Esotropia exceeded 45° and hypotropia exceeded 15° in her right eye in the Hirschberg test. Right eye duction was markedly limited in every gaze direction. Orbital magnetic resonance images showed rupture of the superior rectus to lateral rectus band ligament and lengthening of the distance between the SR and LR muscles in the right eye. DIAGNOSIS Due to the patient's ophthalmic examination and imaging results, she was diagnosed with high myopic strabismus fixus. INTERVENTIONS We performed MR recession and Yokoyama surgery to correct right eye hypoesotropia. In the MR recession procedure, pulled-in-two syndrome (MR muscle tear) occurred. Thus, no additional procedure was performed on the MR. After the surgery, she presented 45 prism diopter exotropia and 18 prism diopter residual right hypotropia in a Krimsky test. We performed a second surgery, combining MR muscle advancement and inferior rectus (IR) muscle recession, 3 months after the first surgery. OUTCOMES One and a half years after the second surgery, she presented exotropia of 14 prism diopters without hypotropia in the Krimsky test and was satisfied with her ocular position and improved motility. LESSONS We experienced pulled-in-two syndrome in a case with severe myopic strabismus fixus and achieved a good outcome by performing additional surgery 3 months later, in which the lost MR muscle was advanced. This case underscores that, if the lost muscle cannot be found during surgery, one should maintain composure and perform a reoperation a few months after the initial surgery, if necessary. This case report can aid in making rescue treatment decisions when pulled-in-two syndrome occurs.
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Affiliation(s)
- Shinya Nakao
- Department of Ophthalmology, Tenri Hospital, Tenri, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * Correspondence: Manabu Miyata, Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan (e-mail: )
| | - Mariko Hirai
- Department of Ophthalmology, Tenri Hospital, Tenri, Japan
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Kassem RR, Badr RAA, Al Zarea BKA, Almasaud JS, Alshomer FM, El-Sada MA, Zedan RH. Botulinum Toxin Injection in Horizontal Rectus Muscles Without Electromyography Using an Open Sky Versus a Closed Sky Technique. J Pediatr Ophthalmol Strabismus 2022; 59:388-395. [PMID: 35275777 DOI: 10.3928/01913913-20220210-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To ascertain whether electromyographic control when injecting botulinum toxin in the horizontal rectus muscles is necessary, and to compare the open sky and closed sky injection techniques that are used without electromyographic control. METHODS The records of 135 patients with horizontal strabismus who received botulinum toxin injections were reviewed retrospectively. Sevoflurane or propofol anesthesia was used in children, and topical benoxinate hydrochloride was used in adults. Patients received a bilateral injection of 2.5 to 15 IU of botulinum toxin, without electromyographic control, into the medial or lateral rectus muscles to correct esotropia or exotropia, respectively. An open sky technique was used in 31 patients, and a closed sky technique was used in 104 patients. Postoperative alignment within 10 prism diopters (PD) of orthotropia was considered a successful outcome. RESULTS A successful outcome at 6 months of follow-up was achieved in 47% of all patients: 59% of patients in the open sky group and 44% of patients in the closed sky group (P = .151). Botulinum toxin injection corrected a mean of 14 ± 9.705 PD in patients in the open sky group and 31 ± 20.589 PD in patients in the closed sky group to obtain mean residual angles of 21 ± 16.692 and 13 ± 11.901 PD, respectively. CONCLUSIONS The results obtained without electromyographic assistance were not remarkably different from the studies using electromyographic control. Moreover, because the results of the open sky technique were not significantly superior to the closed sky technique, the latter was favored to shorten the operative time and postoperative convalescence, and to reduce the risk of postoperative adhesions and scarring, which made re-operations difficult. [J Pediatr Ophthalmol Strabismus. 2022;59(6):388-395.].
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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. Arch Soc Esp Oftalmol (Engl Ed) 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Alnajjar T, Sesma G, Alfreihi S. Conventional surgery versus botulinum toxin injection for the management of esotropia in children with Down syndrome. J AAPOS 2022; 26:251.e1-251.e4. [PMID: 36116586 DOI: 10.1016/j.jaapos.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/01/2022] [Accepted: 06/10/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the success rates of strabismus surgery and botulinum toxin injection (BTX) in treating esotropia in patients with Down syndrome (DS). METHODS This multicenter retrospective cohort study included all consecutive patients having DS with esotropia between 2014 and 2021 at King Abdullah Specialist Children Hospital, King Abdullah International Medical Research Center, and King Khaled Eye Specialist Hospital, Saudi Arabia. We divided the patients into two groups according to interventions. Success was defined as angle of deviation of <10Δ at final visit. RESULTS A total of 53 patients were included: 23 in the surgery group and 30 in the BTX group. There were no significant differences between groups with regard to age, sex, diagnosis, spherical equivalent, and preoperative deviation angle. Before the intervention, the median angle of deviation was 30.0Δ (IQR, 30Δ-45Δ) in the surgery group and 37.5Δ (IQR, 28.8Δ-50.0Δ) in the BTX group (P = 0.802). Postoperatively, the median (IQR) deviation angle was 0.0Δ (0.0Δ-16.0Δ) in the surgery group and 22.5Δ (6.75Δ-30.0Δ) in the BTX group (P = 0.006). The success rate in the surgery and BTX groups was 65% and 30%, respectively (P = 0.011). Two patients developed dissociated vertical deviation in the surgery group. One patient presented consecutive exotropia and one inferior oblique overaction in the BTX group. CONCLUSIONS In this study, conventional surgery showed a higher success rate than BTX in the management of esotropia.
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Affiliation(s)
- Taghreed Alnajjar
- Department of Ophthalmology, Heraa General Hospital, Mecca, Saudi Arabia; King Abdullah International Medical Research Center, National Guards, Riyadh, Saudi Arabia
| | - Gorka Sesma
- Department of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Shatha Alfreihi
- King Abdullah International Medical Research Center, National Guards, Riyadh, Saudi Arabia; Pediatric Ophthalmology Division, Pediatric Surgery Department, King Abdullah Specialist Children Hospital, National Guard Health Affairs, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences.
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22
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Huang X, Meng Y, Hu X, Zhao Y, Ye M, Yi B, Zhou L. The Effect of Different Treatment Methods on Acute Acquired Concomitant Esotropia. Comput Math Methods Med 2022; 2022:5001594. [PMID: 35502413 PMCID: PMC9056260 DOI: 10.1155/2022/5001594] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/30/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022]
Abstract
Objective The application of botulinum toxin type A (BTXA) in the treatment of paralytic strabismus has been recognized, but there are few studies on the treatment of acute acquired comitant esotropia (AACE). This study was aimed to investigate the clinical characteristics of AACE and compare the therapeutic effects of BTXA and traditional surgery. Methods 78 patients with AACE in Renmin Hospital of Wuhan University between March 2019 and March 2021 were reviewed. The relevant medical records of the patients were collected, and they were divided into surgical group (n = 46) and botulinum toxin type A (BTXA) group (n = 32) according to different treatment approaches. The surgical group was treated with squint correction, whereas the BTXA group was treated with microinjection of BTXA in MR. Eye alignment, esotropia, stereopsis, and complications were examined before and after treatment in both groups. Results The refractive status of 78 patients with AACE was mostly myopic refractive error. In general, the angle of esotropia at distance was larger than which at near, with a statistically significant difference. At follow-up assessments of 1 week, 1 month, 3 months, and 6 months after treatment, the total effective rates of the surgical group and the BTXA group were 100% and 90.48%, respectively. The residual angle of esotropia of both groups was lower after treatment. Additionally, the incidence rate of complications in the BTXA group was significantly lower than that in the surgical group. Conclusion AACE occurs mostly in people with myopic refractive errors and is associated with prolonged near work. Besides surgical treatment, micro-injection of BTXA is also an effective and safe treatment for AACE.
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Affiliation(s)
- Xiaoqi Huang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yanfang Meng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xuemin Hu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yijia Zhao
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Meihong Ye
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Beixi Yi
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Lianhong Zhou
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, China
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Shen T, Kang Y, Lin X, Wu H, Yan J. Newly developed abnormal head position and secondary esotropia after strabismus surgery for children with intermittent exotropia. Int Ophthalmol 2022; 42:2965-2972. [PMID: 35083599 DOI: 10.1007/s10792-021-02173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To review cases of newly developed AHP and secondary esotropia (ET) after surgical correction for IXT. METHODS Medical records of cases with newly developed AHP and secondary ET after surgical correction for IXT were retrospectively reviewed. RESULTS Fifteen cases were included and the mean pre-operative exodeviation was 31.7 ± 10.6 prism diopters (PD) (range: 16-50) at distance. They received bilateral lateral rectus (LR) recessions (13/15), unilateral LR recession and medial rectus (MR) resection (1/15) or bilateral LR recession plus unilateral MR resection (1/15). Fourteen patients developed chin-down AHP with secondary V-pattern ET and 1 presented chin-up AHP with secondary A-pattern ET. The mean esodeviation in primary gaze was 22.7 ± 10.0 PD (range: 3-40) at distance. Twelve cases underwent a second surgery for correction of AHP and secondary ET, and approximately half (5/11) of the recessed LR muscles explored showed a 3-5 mm downward displacement of the new attachment. Surgical management mainly included advancement of LR to the original insertion with a 3-5 mm upward transposition. The AHP dissipated and ocular alignment returned to normal in all of these cases. Three cases did not require further surgery, and their AHP and secondary ET were no longer present at 2-5 months after the first surgery. CONCLUSION A downward shift of the recessed LR in IXT may lead to secondary V-pattern ET and development of a chin-down AHP. Advancement of LR with an upward transposition serves as an effective procedure for the correction of this complication.
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Affiliation(s)
- Tao Shen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 54 Xianlie S. Road, Guangzhou, 510060, Guangdong, China
| | - Ying Kang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 54 Xianlie S. Road, Guangzhou, 510060, Guangdong, China
| | - Xiaoming Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 54 Xianlie S. Road, Guangzhou, 510060, Guangdong, China
| | - Heping Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 54 Xianlie S. Road, Guangzhou, 510060, Guangdong, China
| | - Jianhua Yan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 54 Xianlie S. Road, Guangzhou, 510060, Guangdong, China.
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Mendonça TS, Rossetto JD, Correa AB, Plut M. New Surgical Interlacing Technique for Correction of Highly Myopic Strabismus. J Pediatr Ophthalmol Strabismus 2022; 59:e1-e6. [PMID: 35072553 DOI: 10.3928/01913913-20211101-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This interventional case series describes a new surgical interlacing procedure for esotropia correction in patients with high myopia. The technique consists of superior and lateral rectus tendon splitting, lateral rectus superior half passage within the undisinserted superior rectus muscle, and its reattachment at the original insertion. Surgical results showed marked improvement in alignment and abduction. [J Pediatr Ophthalmol Strabismus. 2022;59(1):e1-e6.].
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Chung SA, Choi YJ, Kwak JJ. Acquired Esotropia in an Adolescent Wearing Orthokeratology Lenses. J Pediatr Ophthalmol Strabismus 2022; 59:e7-e10. [PMID: 35072556 DOI: 10.3928/01913913-20211101-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Orthokeratology is a procedure involving the use of reverse-geometry lenses to temporarily correct refractive errors. Switching from spectacles to orthokeratology lenses may influence binocular visual function and accommodation. This is the first report of orthokeratology lens-associated acquired esotropia, a form of distance esotropia, in an adolescent with myopic anisometropia. [J Pediatr Ophthalmol Strabismus. 2022;59(1):e7-e10.].
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Lai YF, Lee LC, Chen YH, Chien KH. "Pulsating proptosis and heavy eye syndrome precipitated by neurofibromatosis type 1: A case report". Medicine (Baltimore) 2021; 100:e27575. [PMID: 34678901 PMCID: PMC8542118 DOI: 10.1097/md.0000000000027575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/07/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Neurofibromatosis type 1 (NF1) is a hereditary disease characterized by café-au-lait spots, peripheral neurofibromas, Lisch nodules, optic nerve glioma, and sphenoid wing dysplasia. Pulsating proptosis is associated with a sphenoid bony defect. Heavy eye syndrome is characterized by acquired esohypotropia in patients with high myopia. This study aimed to describe the presentation of pulsating proptosis and heavy eye syndrome precipitated by NF1 and its management. PATIENT CONCERNS A 41-year-old woman presented with progressive pulsating proptosis and hypodeviation of the right eye over the past 2 years. The axial length of the right eye was 36.81 mm. The right eye presented with esohypotropia and hypoglobus. The ocular motility examination showed limitations in all directions, especially in supraduction. Brain computed tomography revealed sphenoid wing dysplasia of the right orbit. The meningocele protruded through the orbital defect, lifting the globe. Brain magnetic resonance imaging demonstrated superior rectus muscle (SR) medial displacement and lateral rectus muscle inferior displacement. Physical examination revealed café-au-lait macules and neurofibromas on the trunk. DIAGNOSIS NF1 with pulsating proptosis and heavy eye syndrome. INTERVENTIONS The patient declined neurosurgery due to risk and economic reasons. To manage her main concern regarding cosmetics, we performed orbital floor decompression, SR resection with advancement, maximal hang-back recession of the inferior rectus muscle, and a partial Jensen's procedure. OUTCOMES Proptosis was reduced. The eye position became more symmetrical. The range of eye movements was also increased. LESSONS This case describes a rare synchronous presentation of pulsating proptosis and heavy eye syndrome precipitated by NF1. Adult-onset presentation implied a progressive process in NF1. The case also showed a different etiology from that of typical heavy eye syndrome. It reminds ophthalmologists that orbital imaging should be performed in high myopia patients with strabismus to evaluate the extraocular muscle pathway. Furthermore, the case demonstrated a management that avoided the risk and expensive cost of neurosurgery, which has not been reported.
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Chen JC, Schmid KL, Brown B, Edwards MH, Yu BSY, Lew JKF. AC/A ratios in myopic and emmetropic Hong Kong children and the effect of timolol§. Clin Exp Optom 2021; 86:323-30. [PMID: 14558854 DOI: 10.1111/j.1444-0938.2003.tb03128.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2002] [Revised: 07/17/2003] [Accepted: 07/26/2003] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Caucasian children with myopia have elevated response accommodative vergence to accommodation (AC/A) ratios. The purpose of this study was twofold: to determine if response AC/A ratios vary with refractive error and with myopic progression rate in Hong Kong Chinese children, and to determine the effect of beta-adrenergic antagonism with topical timolol application on AC/A ratios. METHODS Thirty children aged eight to 12 years participated in the study. All refractive errors were corrected with spectacle lenses. Accommodative responses were measured using a Shin-Nippon autorefractor and concurrent changes in vergence were assessed using a vertical prism and a Howell-Dwyer card at three metres and 0.33 metre. Accommodative demand was altered using plus or minus two dioptre lenses and lens- and distance-induced response AC/A ratios were calculated. Measurements were repeated 30 minutes after the instillation of topical timolol maleate (0.5 per cent). RESULTS AC/A ratios appeared higher in progressing myopic children but the difference was not statistically significant. Timolol application reduced accommodative convergence (AC) in the stable myopes (reduction = -3 +/- 1.14 prism dioptres) but not in the emmetropes (0.69 +/- 0.96 prism dioptres) or progressing myopes (0.16 +/- 0.43 prism dioptres) and this difference between refractive groups was statistically significant (F(2, 27) = 3.766; P = 0.036). However, timolol did not produce a significant change in the accommodative response to positive or negative lenses or response AC/A ratios. CONCLUSIONS We did not find that AC/A ratios in myopic Chinese children were elevated and therefore, it is unlikely that elevated AC/A ratios are responsible for the high levels of myopia that occur in Hong Kong. The finding that timolol reduced AC in the stable myopes suggests that the autonomic control of accommodative convergence in these children may be different from that in emmetropic children and those with progressing myopia.
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Affiliation(s)
- Jennifer C Chen
- Centre for Eye Research, School of Optometry, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
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Ha SG, Kim SH. Initial Postoperative Alignment in Strabismus Related to Thyroid Eye Disease. J Pediatr Ophthalmol Strabismus 2021; 58:23-27. [PMID: 33495794 DOI: 10.3928/01913913-20200910-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/12/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the surgical outcome according to the initial postoperative angle of deviation in patients with thyroid eye disease. METHODS The medical records of patients who underwent strabismus surgery were retrospectively reviewed. The patients were divided into overcorrection (> 5 prism diopters [PD]), full correction, or undercorrection (> 5 PD) groups, according to the angle of deviation on postoperative day 1. The surgical outcome was considered successful when there was no diplopia vertically (< 5 PD) and horizontally (< 10 PD) at primary gaze. Surgical success rates were evaluated according to the initial postoperative angle of deviation at the final visit. RESULTS Seventy-eight patients were enrolled in this study. The mean age of the patients was 53.4 ± 9.5 years, and the mean follow-up duration was 17.4 ± 8.7 months. There were 51 patients with hypotropia and 27 patients with esotropia. Success rates for hypotropia were higher in the undercorrection (80.0%) and full correction (66.7%) groups than in the overcorrection (35.7%) group on postoperative day 1 (P = .02). Regarding esotropia, the success rates were higher in the undercorrection (84.6%) and full correction (83.3%) groups than in the overcorrection (37.5%) group on postoperative day 1 (P = .02). Reoperation for residual or overcorrected strabismus was performed in 15 patients (29.4%) with hypotropia and 7 patients (25.9%) with esotropia. CONCLUSIONS Intended minimal undercorrection or full correction after hypotropia and esotropia surgery during early postoperative periods could improve surgical success rates in patients with thyroid eye disease. [J Pediatr Ophthalmol Strabismus. 2021;58(1):23-27.].
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [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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Abdallah MEI, Eltoukhi EM, Awadein AR, Zedan RH. Superior Rectus Transposition With Medial Rectus Recession Versus Medial Rectus Recession in Esotropic Duane Retraction Syndrome. J Pediatr Ophthalmol Strabismus 2020; 57:309-318. [PMID: 32956481 DOI: 10.3928/01913913-20200506-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/14/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the results of augmented superior rectus transposition (with or without medial rectus recession) with simple medial rectus recession in the treatment of patients with esotropic Duane retraction syndrome. METHODS This was a prospective, randomized, and interventional comparative study of 20 patients with esotropic type 1 Duane retraction syndrome. Patients were randomly divided into two groups. In the first group (superior rectus transposition group), superior rectus transposition with or without medial rectus recession was performed. In the second group (non-superior rectus transposition group), unilateral medial rectus recession was performed. RESULTS Each group included 10 patients. Esotropia improved from 20.4 prism diopters (PD) preoperatively to 0.6 PD postoperatively in the superior rectus transposition group and from 22.5 PD preoperatively to 0.9 PD postoperatively in the non-superior rectus transposition group. Face turn improved from 11.5° preoperatively to 0.5° postoperatively in the superior rectus transposition group and from 12° preoperatively to 1.5° postoperatively in the non-superior rectus transposition group. Abduction improved in the superior rectus transposition group from -3.9 preoperatively to -3.1 postoperatively and from -3.9 preoperatively to -3.6 postoperatively in the non-superior rectus transposition group. Vertical deviation developed in two cases in the superior rectus transposition group. CONCLUSIONS Both superior rectus transposition and medial rectus recession are effective in the elimination of esotropia and face turn in patients with esotropic Duane retraction syndrome. Superior rectus transposition is more effective in improving abduction, but it can be complicated by vertical deviation. [J Pediatr Ophthalmol Strabismus. 2020;57(5):309-318.].
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Kudrna JJ, Dryden SC, Richardson CR, Choudhri AF, Kerr NC. Unilateral Abducens Nerve Palsy Following Perinatal Stroke of the Middle Cerebral Artery. J Pediatr Ophthalmol Strabismus 2020; 57:e30-e33. [PMID: 32176807 DOI: 10.3928/01913913-20200219-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/13/2020] [Indexed: 11/20/2022]
Abstract
The authors describe a case of unilateral abducens nerve palsy following perinatal stroke of the middle cerebral artery. A 1-year-old boy presented with left eye esotropia but no other ocular abnormalities. The patient's history, examination, and diagnostic tests were consistent with abducens nerve palsy. He underwent left medial rectus recession of 5.5 mm and left lateral rectus resection of 7 mm followed by patching. At 15 months after surgery, primary gaze by prism alternate cover testing revealed a 4 prism diopter (PD) esophoria (small angle in left gaze with essentially no action of lateral rectus) and 2 PD right hyperphoria. Ophthalmologic management of abducens nerve palsy entails addressing neurological sequelae in a timely manner, treating the esotropia and strabismic amblyopia to optimize visual system development. [J Pediatr Ophthalmol Strabismus. 2020;57:e30-e33.].
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Li YW, Yang SQ, Zhang W, Guo X. [The surgical effect of secondary esotropia with diplopia after orbital decompression for thyroid-associated ophthalmopathy]. Zhonghua Yan Ke Za Zhi 2020; 56:183-188. [PMID: 32187946 DOI: 10.3760/cma.j.issn.0412-4081.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: To evaluate the effect of extraocular muscle surgery in treating secondary esotropia with diplopia after orbital decompression for thyroid-associated ophthalmopathy (TAO). Methods: Retrospective case series study. Eleven secondary esotropic patients with diplopia after orbital decompression for TAO who underwent extraocular muscle surgery during March 2016 and October 2018 in Tianjin Eye Hospital were included. All patients had new onset esotropia after decompression surgery and underwent strabismus surgery. Deviation angle, diplopia, and ocular movement were observed preoperatively and postoperatively. Surgeries were carried out under the monitored anesthesia care combined with local anesthesia, and the eye alignment was adjusted to orthotropia with no diplopia in the operation with the technique of intraoperative adjustable suture and forced duction test results. All the patients were followed up. Results: The ages of the patients were from 26 to 42 years (1 male and 10 females). The deviation angles were 10-98 prism diopter. Orbital CT scan showed that the horizontal rectus thickness was increased at different levels, and the thickness of the medial rectus was increased more than that of the lateral rectus. Two patients had monocular medial rectus recession only, 2 had bilateral medial rectus recession only, 2 had monocular medial rectus recession combined with lateral rectus resection, and the other 5 had bilateral medial rectus recession with monocular lateral rectus resection. The recession of medial rectus muscle was 3.5 to 7.5 mm in 11 patients and 2.0 to 6.0 mm in 7 patients with the resection of lateral rectus muscle. Diplopia of the 11 patients disappeared with orthotropia at primary gaze position after the extraocular muscle surgery. The limitation of abduction changed from preoperative (-1.91±1.04) to postoperative (-0.64±0.81). All the patients were satisfied with the surgical results. At the end of the follow-up (6 to 24 months), the results of the patients were stable, and no over-correction was found. Conclusion: Extraocular muscle surgery with intraoperative adjustable suture technique can effectively treat TAO patients with secondary esotropia with diplopia after orbital decompression. (Chin J Ophthalmol, 2020, 56: 183-188).
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Affiliation(s)
- Y W Li
- Tianjin Eye Hospital, Tianjin Key Lab. of Ophthalmology and Visual Science, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin 300020, China, is a doctor of continuing education, working at the Department of Ophthalmology, the First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
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Chun BY, Freire MV, Cestari DM. Surgical Responses and Outcomes of Bilateral Medial Rectus Recession in Esotropia With Spinocerebellar Ataxia. J Pediatr Ophthalmol Strabismus 2019; 56:266-270. [PMID: 31322719 DOI: 10.3928/01913913-20190514-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/09/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the surgical responses and outcomes of bilateral medial rectus (BMR) recession in esotropic patients with spinocerebellar ataxia (SCA) and to compare the results with normal controls. METHODS The medical records of patients with SCA who underwent strabismus surgery for esotropia between 2006 and 2015 were reviewed retrospectively. Five esotropic patients with SCA (SCA group) and 10 esotropic patients without neurologic disorders (control group) who underwent BMR recession were included. Success rates, surgical responses, and the amount of preoperative and postoperative distance-near disparity were evaluated and compared between the groups. RESULTS The mean preoperative esodeviation was not different between the SCA and control groups (20 vs 17.3 prism diopters [PD], P = .214). However, patients with SCA showed significant undercorrection compared with controls 1 week postoperatively (4.8 vs 1.0 PD, P = .048) and at the final follow-up (6.8 vs 1.8 PD, P = .032). The surgical success rates for the SCA and control groups were 40% and 80%, respectively (P = .095). Patients with SCA demonstrated a significantly reduced surgical response compared with controls (3.15 vs 3.87 PD/mm, P = .004), and a greater amount of postoperative distance-near disparity than controls (8.0 vs 1.1 PD, P = .001). CONCLUSIONS A significant undercorrection was observed following BMR recession in esotropic patients with SCA. Accordingly, the authors recommend a slight overcorrection of 5 to 10 PD or adding a slanting procedure when planning strabismus surgery for this distinct group of patients. [J Pediatr Ophthalmol Strabismus. 2019;56(4):266-270.].
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Rothfield L, Cavuoto KM, Reyes-Capo DP, Vanner EA, Grace SF, Capo H. Postoperative Correction and Drift After Vertical Rectus Muscle Transposition for Total Sixth Cranial Nerve Palsy. J Pediatr Ophthalmol Strabismus 2019; 56:238-242. [PMID: 31322714 DOI: 10.3928/01913913-20190322-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/19/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the magnitude of change between the preoperative and postoperative alignment and amount of postoperative drift for two vertical rectus muscle transpositions (VRTs). METHODS Retrospective review of medical records of patients with total sixth cranial nerve palsy who underwent VRT procedures. The primary outcome measure was the magnitude of esotropia in prism diopters (PD) at the preoperative and postoperative visits. RESULTS Twenty-seven patients were included. Sixteen had full tendon transposition with Foster augmentation (FTT+FA) and 11 had partial tendon transposition with resection and simultaneous medial rectus recession (PTT+R+MRR). A larger correction was obtained with PTT+R+MRR (mean ± standard deviation [SD]: 52 ± 19 PD; range: 27 to 87 PD) when compared to FTT+FA (mean: 40 ± 13 PD; range: 15 to 68 PD). At postoperative month 2, a greater esotropic drift was noted in the PTT+R+MRR group (16 PD) than the FTT+FA group (6 PD). Although the difference in the amount of correction was not statistically significant (P = .071), the difference in the amount of drift was statistically significant (P = .009). CONCLUSIONS There was a trend toward greater correction with PTT+R+MRR than FTT+ FA, but it was not statistically significant. FTT+FA had significantly less postoperative drift than PTT+R+MRR. The results suggest that a small immediate postoperative overcorrection may be desirable in some VRT procedures. [J Pediatr Ophthalmol Strabismus. 2019;56(4):238-242.].
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Gadgil N, Edmond J, Stormes K, Lam S, Shah V. Visual Complications of Pediatric Posterior Fossa Tumors: Analysis of Outcomes. Pediatr Neurol 2019; 92:48-54. [PMID: 30661932 DOI: 10.1016/j.pediatrneurol.2018.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Visual abnormalities are common among children with posterior fossa tumors, resulting from disruption of ocular afferent and efferent systems due to the tumor or surgery. This study describes the visual complications and outcomes associated with these tumors. METHODS Clinical and radiographic data of patients who underwent index surgery for resection of posterior fossa tumor from 2007 to 2016 were reviewed. Descriptive statistics, univariate, and multivariate regression were performed to assess factors contributing to visual acuity and postoperative strabismus. RESULTS There were 182 patients who underwent posterior fossa craniotomy for neoplasm were included. Ophthalmologic symptoms were the fourth most common presenting complaint; initial ophthalmologic examination was abnormal in 40% of patients. Evaluation of visual acuity demonstrated a good outcome in 88% of patients following treatment. The most common postoperative oculomotor finding was esotropia (29%) which resolved spontaneously in more than half of patients. A good outcome was obtained in all patients who underwent surgery for esotropia. Hypertropia was noted in 14% of the cohort and less than half resolved spontaneously; less than half undergoing strabismus surgery for hypertropia had a good outcome. Multivariate analysis confirmed the association between cerebellar mutism and postoperative esotropia and hypertropia. Clinically significant pathological nystagmus was seen in 8% of the cohort. CONCLUSIONS Our results indicate a good visual outcome in the majority of pediatric patients undergoing resection of posterior fossa tumors. Ophthalmologic complications should be appropriately evaluated and addressed to allow for the best possible vision to survivors of posterior fossa tumors.
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Affiliation(s)
- Nisha Gadgil
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Jane Edmond
- Mitchel and Shannon Wong Eye Institute, Department of Ophthalmology, Dell Medical School, Austin, Texas
| | - Katie Stormes
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Sandi Lam
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Veeral Shah
- Department of Ophthalmology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas.
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Tannen B, Good K, Ciuffreda KJ, Moore KJ. Prevalence of esophoria in concussed patients. J Optom 2019; 12:64-68. [PMID: 29602686 PMCID: PMC6318546 DOI: 10.1016/j.optom.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 06/02/2023]
Abstract
PURPOSE To assess the prevalence of esophoria at near in concussed patients in a neuro-optometric private practice setting. METHODS A retrospective analysis was performed involving a chart review in a neuro-optometric, private practice setting of consecutive patients with a medical diagnosis of concussion from January 1st 2016 to December 31st 2016. A total of 71 patients were included in the analysis. All received a comprehensive vision examination, with a near vision emphasis. The near horizontal phoria was assessed with the cover test and the von Graefe test. RESULTS Approximately 30% of the patients with a medically based diagnosis of concussion exhibited esophoria at near, with good agreement (95%) between the two tests. Mean esophoria was 5.2 (SD=2.8) prism diopters (pd), with a range from 2pd to 14pd of esophoria. Convergence excess was diagnosed in 23%. DISCUSSION Near esophoria was found in nearly one-third of this practice-based sample of concussed patients. Thus, it was more common than typically believed to be the case. Two proposed oculomotor-based mechanisms related to these symptomatic esophoric patients included phoria decompensation and excessive accommodative vergence.
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Affiliation(s)
- Barry Tannen
- Private Practice, EyeCare Professionals, PC, Hamilton Square, NJ, United States.
| | - Kalynn Good
- Private Practice, Costa Mesa, CA 92626, United States
| | | | - Kelsey J Moore
- Vision Therapy and Neuro-optometric Rehabilitation, EyeCare Professionals, PC, Hamilton Square, NJ, United States
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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] [What about the content of this article? (0)] [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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Oku H, Nishikawa Y, Kida T, Tonari M, Sugasawa J, Ikeda T. Convergent strabismus fixus after bilateral abducens nerve palsies due to aneurysms: A case report. Medicine (Baltimore) 2018; 97:e13766. [PMID: 30572527 PMCID: PMC6320112 DOI: 10.1097/md.0000000000013766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Convergent strabismus fixus is an ocular motor abnormality in which the eye is fixed in adduction. This condition is mostly associated with high myopia and is caused by a displacement of the extraocular muscles. We report a nonmyopic woman with convergent strabismus fixus due to aneurysms. PATIENT CONCERNS A 79-year-old woman complained of progressive worsening of esotropia about 50 years prior to her visit. Neuroimaging showed that the eye was not dislocated, and the extraocular muscles were not displaced. However, aneurysms were found bilaterally from the intracavernous carotid arteries and the location was on both abducens nerves. DIAGNOSES Chronic bilateral abducens nerve palsies due to aneurysms. INTERVENTIONS Endovascular treatment was successfully performed for the aneurysms. OUTCOMES Convergent strabismus fixus still remained. LESSONS Chronic abducens nerve palsies may develop to nonmyopic convergent strabismus fixus without displacement of extraocular muscles, and mass lesions in the brain including aneurysms should be ruled out when orbital MRI cannot explain the condition.
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Bang SP, Lee DC, Lee SY. Asymmetric Lateral Rectus Muscle Insertion Presenting as Esotropia in a Child With Alagille Syndrome. J Pediatr Ophthalmol Strabismus 2018; 55:e36-e38. [PMID: 30388280 DOI: 10.3928/01913913-20181012-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/03/2018] [Indexed: 11/20/2022]
Abstract
A 2-year-old boy with Alagille syndrome who had esotropia underwent bilateral medial rectus recession. One month postoperatively, esotropia reoccurred and was aggravated thereafter. Right lateral rectus resection was unsuccessful because the insertion site could not be identified. Careful preoperative imaging may be necessary in patients with Alagille syndrome to detect any abnormal extraocular muscle insertion. [J Pediatr Ophthalmol. 2018;55:e36-e38.].
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Qi D, Gao L, Xie J, Yu T. Clinical Research on the Efficacy of Modified Surgery for Esotropia Fixus With High Myopia. J Pediatr Ophthalmol Strabismus 2018; 55:219-224. [PMID: 29709045 DOI: 10.3928/01913913-20180213-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 09/21/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the efficacy of a modified surgical procedure for esotropia fixus with high myopia. METHODS Thirteen patients (15 eyes) with esotropia fixus and high myopia who underwent the Jensen procedure for superior and lateral rectus muscles at Southwest Hospital between February 2014 and December 2015 were retrospectively analyzed. Intraoperatively, the superior rectus and lateral rectus muscles were separated up to 12 to 14 mm posterior to their respective insertion. A medial rectus large recession or rectus tenotomy was performed based on the degree of fibrosis of the medial rectus muscle. Postoperative examinations were performed at 1 day, 2 weeks, 3 months, and 6 months. RESULTS On the first postoperative day, 12 eyes (10 patients) were in the primary position (80.0%), 2 eyes (2 patients) exhibited 5° to 10° esotropia (13.3%), and 1 eye (1 patient) exhibited 15° esotropia (6.7%). At the 2-week follow up, 1 eye (1 patient) was lost to follow-up, 9 eyes (7 patients) were in the primary position (64.3%), 3 eyes (3 patients) exhibited 10° esotropia (21.4%), and 2 eyes (2 patients) exhibited 15° to 20° esotropia (14.3%). At the 3-month follow-up, the patient whose ocular alignment was 20° esotropia at 2 weeks was found to have developed 30° esotropia; no change was observed in the other patients. A remarkable improvement in ocular motility was observed in all patients. CONCLUSIONS The Jensen procedure for the union of the superior rectus and lateral rectus muscles, using two pairs of sutures applied 12 to 14 mm posterior to their respective insertions, yielded favorable outcomes. [J Pediatr Ophthalmol Strabismus. 2018;55(4):219-224.].
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Bianchi PE, Guagliano R, Salati R, Traselli GP, Trimarchi F. Esotropia and Pseudoexotropia in Acute Rop Sequelae: Clinical Features and Suggestions for Treatment. Eur J Ophthalmol 2018; 6:446-50. [PMID: 8997590 DOI: 10.1177/112067219600600418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report five cases with a mixture of esotropia and pseudoexotropia due to macular ectopia related cicatricial retinopathy of prematurity (ROP). On inspection, the patients, aged from 9 to 28 years, presented a divergence of the eyes and a nasally decentralised corneal light reflex. The cover test showed esodeviation. All the cases presented some clinical features common to congenital strabismus. Fundus examination showed temporal traction of vascular and retinal tissues and macular ectopia, referrable to cicatricial sequelae of spontaneously regressed severe ROP. Treatment is limited to follow-up, with attention being paid to the control of retinal damage rather than to resolving the esthetic defects. Despite cryotherapy, these conditions are increasing with the increase in severe ROP and are now relatively frequent. We suggest that they be carefully identified in order to avoid incorrect orthoptic or surgical treatment.
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Affiliation(s)
- P E Bianchi
- Eye Clinic, University of Pavia, IRCCS San Matteo Hospital, Italy
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Kinori M, Schwartzstein H, Zeid JL, Kurup SP, Mets MB. Congenital lymphocytic choriomeningitis virus-an underdiagnosed fetal teratogen. J AAPOS 2018; 22:79-81.e1. [PMID: 29274373 DOI: 10.1016/j.jaapos.2017.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 07/19/2017] [Accepted: 08/14/2017] [Indexed: 11/18/2022]
Abstract
Congenital lymphocytic choriomeningitis virus (LCMV) infection is associated with high mortality and morbidity. Although the number of cases reported in the literature has been increasing, it might still be clinically an underdiagnosed human fetal teratogen. We report 2 more cases of serologically proven congenital LCMV infection. One case presented with Aicardi-like syndrome features. Since congenital LCMV infection may mimic Aicardi syndrome, serologic testing should be considered in the workup of patients with Aicardi syndrome to rule out LCMV infection.
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Affiliation(s)
- Michael Kinori
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Hal Schwartzstein
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Janice Lasky Zeid
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sudhi P Kurup
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Marilyn B Mets
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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Cho SY, Lee SY. Reduction of Consecutive Esotropia Using Modified Contralateral Recession and Resection for Recurrent Intermittent Exotropia. J Pediatr Ophthalmol Strabismus 2018; 55:53-58. [PMID: 28991342 DOI: 10.3928/01913913-20170703-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 05/26/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To report consecutive esotropia in contralateral lateral rectus recession and medial rectus resection for recurrent intermittent exotropia after unilateral lateral rectus recession and medial rectus resection and to evaluate the surgical outcome of modified contralateral lateral rectus recession and medial rectus resection for exotropia after unilateral lateral rectus recession and medial rectus resection. METHODS A total of 36 patients were included in this retrospective study. As a primary surgery for exotropia, all patients underwent unilateral lateral rectus recession and medial rectus resection on the non-dominant eye. Patients were subsequently assigned to either conventional contralateral lateral rectus recession and medial rectus resection (surgical dosages based on Wright's surgical table) (n = 19; conventional group) or modified contralateral lateral rectus recession and medial rectus resection (surgical dosages reduced by 5 prism diopters on Wright's surgical table) (n = 17; modified group) for recurrent exotropia. Surgical success rates were evaluated. Reoperation or prism glasses prescription rates due to consecutive esotropia were evaluated. RESULTS The mean follow-up durations after reoperation were 25.8 and 24.0 months in the conventional and modified groups, respectively. The surgical success rates were 73.7% and 82.4% (P = .538, Fisher's exact test) and the recurrence rates were 0% and 17.6% (P = .059, Fisher's exact test), respectively. The reoperation or prism glasses prescription rates due to consecutive esotropia were 26.3% and 0%, respectively (P = .025, Fisher's exact test). CONCLUSIONS Final outcomes were better in the modified group compared to the conventional group. Consecutive esotropia was significantly more frequent in the conventional group than in the modified group. In surgery for recurrent exotropia, a reduction of the surgical dosage will reduce the incidence of consecutive esotropia. [J Pediatr Ophthalmol Strabismus. 2018;55(1):53-58.].
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Zheng Y, Donahue SP. Bilateral Superior Rectus Transposition With Bilateral Medial Rectus Recession for Möbius Syndrome. J Pediatr Ophthalmol Strabismus 2017; 54:e81-e82. [PMID: 29156061 DOI: 10.3928/01913913-20170907-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/08/2017] [Indexed: 11/20/2022]
Abstract
Bilateral superior rectus transposition with bilateral medial rectus recession has been described successfully for treatment of Duane's syndrome but never for Möbius syndrome. The authors describe a child with Möbius syndrome who presented with large bilateral abduction deficits and esotropia. This surgical treatment resulted in marked improvement of said deficits. [J Pediatr Ophthalmol Strabismus. 2017;54:e81-e82.].
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Li YP, Zhang W. [Advances in research of divergence insufficiency]. Zhonghua Yan Ke Za Zhi 2017; 53:552-556. [PMID: 28728290 DOI: 10.3760/cma.j.issn.0412-4081.2017.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Divergence insufficiency is acquired esotropia at distance fixation with symptomatic uncrossed diplopia but fusion at near. It can be divided into two forms: primary isolated form and secondary form associated with neurologic abnormalities, also called divergence palsy. The clinical features of divergence insufficiency include small esotropia only at distance but orthotropia or small esophoria at near, comitant deviation at lateral gaze, reduced divergence fusion, full abduction and normal saccadic velocities in abduction. Primary divergence insufficiency is a benign condition predominantly occurring in adults older than 50 years. Recently, studies on the etiology of age-related distance esotropia, also called sagging eye syndrome, have demonstrated that the degenerative changes of orbital tissue could induce the inferior displacement of the inferior rectus pulley, different from the neurological etiology in abducens nerve palsy and secondary divergence insufficiency. The treatment goal is to relieve diplopia. Both prism and regular surgeries including medial rectus recession and lateral rectus resection are effective. Some unusual surgeries have been applied in divergence insufficiency, but further investigations with large samples are needed. The recent research advances in the etiology, diagnosis, differential diagnosis and treatment of divergence insufficiency are reviewed in this article. (Chin J Ophthalmol, 2017, 53: 552-556).
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Affiliation(s)
- Y P Li
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin 300020, China
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Velez FG, Chang MY, Pineles SL. Inferior Rectus Transposition: A Novel Procedure for Abducens Palsy. Am J Ophthalmol 2017; 177:126-130. [PMID: 28254627 DOI: 10.1016/j.ajo.2017.02.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE Superior rectus transposition has been popularized for the treatment of abduction deficiencies. Potential complications include induced vertical deviation and torsion. A new procedure, the inferior rectus transposition (IRT), may be similarly beneficial for patients at risk for postoperative vertical deviation or incyclotropia. The purpose of this study is to describe the outcomes of patients undergoing IRT. DESIGN Prospective, interventional case series. METHODS Five patients in an academic pediatric ophthalmology and strabismus practice with a complete lateral rectus palsy who underwent IRT were studied. Changes in anomalous head posture, ocular rotations, ocular alignment, and torsion preoperatively to postoperatively were compared. RESULTS The patients ranged in age from 19-89 years. There was a significant correction in the angle of esotropia (ET) from 39±17Δ (14-55Δ) to 12 ± 9.8Δ (0-22Δ) postoperatively (P = .02). Two of 5 patients had preoperative hypertropia of the affected eye (1.4 ± 2.2Δ; range, 2-5Δ). One of those had no vertical deviation postoperatively and 1 patient resulted in 2Δ hypotropia. One patient without vertical misalignment preoperatively developed a small postoperative vertical deviation. Torticollis significantly improved from 31.4 ± 11.6° to 5 ± 5.8° (P = .004). All patients improved abduction, with a mean of -4.4 ± 0.5 preoperatively to -3.4 ± 0.9 postoperatively (P = .07). CONCLUSION Initial postoperative follow-up in patients with abducens palsy undergoing IRT shows a significant improvement in ocular alignment and torticollis. In patients with preoperative hypertropia, IRT resulted in a downward shifting effect on the operated eye. IRT may be a beneficial procedure for patients with preoperative hypertropia or intorsion requiring transposition procedures. Future studies with larger populations and longer durations of follow-up will be required before this procedure can be recommended.
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Affiliation(s)
- Federico G Velez
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Melinda Y Chang
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Stacy L Pineles
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
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Singh P, Vijayalakshmi P, Shetty S, Vora P, Kalwaniya S. Double Augmented Vertical Rectus Transposition for Large-Angle Esotropia Due to Sixth Nerve Palsy. J Pediatr Ophthalmol Strabismus 2016; 53:369-374. [PMID: 27537250 DOI: 10.3928/01913913-20160810-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 05/11/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To study the binocular alignment and ocular motility in patients with large-angle esotropia due to sixth nerve palsy treated with double augmented vertical recti transposition. METHODS This was a prospective interventional study. Fifteen patients with non-resolving sixth nerve palsy who underwent surgical correction were included in the study. Fourteen patients also underwent an additional medial rectus recession. Two patients with an associated small vertical deviation had a selective augmentation of one vertical rectus muscle. Binocular alignment, ocular motility, duction limitation, improvement in head posture, induced vertical deviations, and field of diplopia-free binocular single vision (when possible) were analyzed. Successful outcome was defined as a residual horizontal deviation of 10 prism diopters (PD) or less with no vertical deviation at final follow-up (6 months). RESULTS The double augmented Hummelsheim procedure improved esotropia from 58.3 ± 10.8 PD preoperatively to 7.2 ± 5.1 PD postoperatively (P = .001). Three (20%) patients had residual deviation of greater than 10 PD, of which 1 patient had diplopia and was treated with prisms. Postoperative binocular field of vision was performed in 6 patients, the mean of which was 20° for abduction and 45° for adduction. Three of 6 patients had elimination of face turn and the rest had residual head posture of less than 5°. Two patients had an induced vertical deviation of less than 4 PD. In patients who had selective augmentation, the vertical deviation was completely corrected. CONCLUSIONS The patients operated on with double augmentation of the Hummelsheim procedure combined with medial rectus recession had reduced mean primary esotropia and improved diplopia-free field of vision postoperatively. [J Pediatr Ophthalmol Strabismus. 2016;53(6):369-374.].
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Sato FRL, Tavares RC. Abducens palsy after temporomandibular joint arthroscopy: a rare complication. Oral Maxillofac Surg 2016; 20:327-330. [PMID: 27146393 DOI: 10.1007/s10006-016-0559-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/20/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Arthroscopy of the temporomandibular joint (TMJ) is a minimally invasive and safe procedure; nevertheless, some accidents and complications have been described in the literature. CASE REPORT The purpose of this article is to describe a case report of a patient that progressed to paralysis of the abducens nerve after a TMJ arthroscopy procedure.
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Affiliation(s)
- Fábio Ricardo Loureiro Sato
- Oral and Maxillofacial Surgery Area, College of Dentistry, State University of São Paulo-UNESP, Av. Eng. Francisco José Longo, 777, São José dos Campos, 12245-000, Brazil.
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Bansal S, Marsh IB. Unaugmented Muscle Union Surgery for Heavy Eye Syndrome Without Combined Medial Rectus Recession. J Pediatr Ophthalmol Strabismus 2016; 53:40-3. [PMID: 26836002 DOI: 10.3928/01913913-20160113-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 11/20/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Simple loop myopexy or retro-equitorial muscle union surgery has been shown to effectively treat the strabismus seen in heavy eye syndrome. In most cases, this has been described with combined recession of the medial rectus muscle, particularly where medial rectus contracture was demonstrated on forced duction testing intraoperatively. The authors report the outcomes of muscle union surgery alone without combined medial rectus recession in 29 eyes with heavy eye syndrome. METHODS A retrospective review was conducted of 26 patients and 29 eyes with heavy eye syndrome treated with a simple loop myopexy procedure. The preoperative and postoperative deviations in primary position were measured along with restriction in ocular motility in abduction and elevation. Patients with residual esotropia and/or persistence of symptoms were offered a second-stage medial rectus recession procedure. RESULTS In 21 patients, muscle union was sufficient in improving the diplopia or cosmetic appearance of the eyes. In these cases, the average preoperative deviation improved from 21.2 ± 16.3 to 5.5 ± 9.1 prism diopters (PD). Eight eyes went on to have a second-stage medial rectus recession with excellent outcomes. CONCLUSIONS The authors found that muscle union surgery alone is an effective and successful procedure in restoring the ocular motility disturbance and also in treating heavy eye syndrome. There was a much lower incidence (up to 70% lower) of medial rectus recession than other similar case series. There were no cases of overcorrection and no complications.
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