ABSTRACT
Purpose@#To evaluate the prevalence of the prism adaptation response in patients with intermittent exotropia (IXT) using the short-term prism adaptation test (PAT) and to assess factors associated with prism adaptation response in IXT patients. @*Methods@#A case-controlled retrospective analysis was performed on 113 patients with IXT without prior surgical treatment.Age, sex, visual acuity, refraction, stereoacuity, control scale, type of exotropia, history of occlusion, and presence of accom-panying visual symptoms were recorded. Prism alternate cover test (PACT) was performed with fixation targets at 6 m and 1/3 m. All patients underwent short-term PAT wearing prism glasses that offset the exodeviation previously measured by PACT. After 30 minutes, angle deviation was measured, and patients were classified into either an increase group, which had an increase in deviation ≥5 prism diopters after short-term PAT, or a no-change group. Analysis was performed to investigate the clinical factors influencing the increase in exodeviation after short-term PAT. @*Results@#Fifty patients (44.2%) showed an increase ≥5 prism diopters during distance or near fixation after short-term PAT compared to the previous PACT: 12 patients (10.6%) showed an increment at distance fixation, and 45 patients (39.8%) showed an increase at near fixation. At distance fixation, the increase-group had a significantly smaller maximum angle measured by PACT. At near distance, age at PAT, maximum distance angle, minimum distance angle, maximum near angle, minimum near angle, angle fluctuation at near, and IXT type showed significant associations with positive short-term PAT response. In the multivariate analysis, older age and smaller maximum near angle were significantly associated with positive short-term PAT response at near fixation. @*Conclusions@#Short-term PAT could be helpful in older IXT patients with a small maximum angle of deviation at near fixation to mitigate the vergence aftereffect and show the maximum angle of deviation.
ABSTRACT
Purpose@#We report two cases of patients who were referred to our clinic with acute acquired comitant esotropia (AACE) andwere then diagnosed with a Chiari I malformation.Case summary: A 15-year-old female presented with acute diplopia for one week. She complained of headache, dizziness, andnausea one week before the onset of diplopia. The angles of esodeviation were concomitant in all directions of gaze, and no limitationin abduction was observed. Fundus photographs showed bilateral papilledema and brain magnetic resonance imagingshowed cerebellar tonsillar herniation. She was diagnosed with acute acquired comitant esotropia associated with Chiari I malformationand was referred to the Neurosurgery Department for consideration of decompression surgery. A 12-year-old malepresented with an acute onset horizontal diplopia for one week. He had a history of dizziness with syncope three months prior tohis visit. He had comitant esotropia in all directions of gaze without any limitation of ocular movement. Brain magnetic resonanceimaging showed cerebellar tonsillar herniation and he was diagnosed with acute acquired comitant esotropia associated withChiari type I malformation. He was treated with bilateral medial rectus muscle recession surgery to correct esotropia and he hadno diplopia after the surgery. @*Conclusions@#When a patient presents with AACE, especially in the presence of neurological symptoms/signs such as headache,syncope, or papilledema, a full neurological examination and prompt neuroimaging are warranted to rule out Chiari Imalformation.
ABSTRACT
Proximal gastrectomy (PG) has been tried as a function-preserving surgery for management of early upper gastric cancer. However, Reflux symptoms and stricture limit its applicability. We designed an anastomosis between the distal part of the posterior esophageal wall and the proximal part of the anterior wall of the stomach to make an anti-reflux mechanism. We named it the SPADE operation owing to its spade-like shape and because it is an acronym for a spade-shaped esophagogastrostomy after PG, which creates a partially duplicated esophagogastric wall. This video illustrates the case of a 74-year-old man diagnosed with early gastric cancer in the high body of the stomach along the greater curvature. We performed a totally laparoscopic proximal gastrectomy and a SPADE operation. He was discharged on the 7th postoperative day with an uneventful postoperative course and resumption of diet without reflux symptoms.