Clinical characteristics of acute acquired comitant esotropia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To describe the clinical characteristics of 20 patients with acute acquired comitant esotropia(AACE). <p>METHODS: This retrospective, observational case series study enrolled patients with AACE examined from June 2018 to May 2021 in Guangdong Jiangmen Central Hospital. The age when attacked, the duration of excessive near work before illness, symptom, refraction, AC/A, deviation and near stereopsis were analyzed. All 20 patients had unremarkable neurological finding by imageological test. <p>RESULTS: Most patients whose mean age was 24.25±5.78 years immersed in near work for more than 6h a day before illness. All patients seeked for medical help because diplopia with normal ocular motility in all directions of gaze and meaningless finding in routine ophthalmologic examinations. They were all nearsightedness whose mean spherical equivalent was -5.73±5.09D, while mean AC/A was 2.65±1.16 within the upper limit. There was no different between the distant and near deviations(<i>P</i>>0.05). Deviations might be correlated with near stereopsis(<i>P</i><0.05), however the duration from onset to treatment was irrelevant(<i>P</i>>0.05).<p>CONCLUSION: The clinical features of AACE in older children and adults who immersed excessive near work are medium myopia, diplopia, normal ocular motility, no neurological finding and limited AC/A. Moreover, it is approximate between distant and near deviations. The deviations affect near stereopsisd more, while the influence of duration from onset to treatment may be less.

Clinical Characteristics and Outcomes of Smartphone Overusers with Acute Acquired Comitant Esotropia

PURPOSE: To evaluate the clinical features and treatment outcomes of smartphone overusers with acute acquired comitant esotropia. METHODS: We retrospectively reviewed the medical records of patients ≥ 15 years of age who used a smartphone for > 4 hours a day for > 1 year, and who were diagnosed with acute acquired comitant esotropia from May 2011 to January 2016. We analyzed sex, age at the time of manifestation and duration of esotropia, refractive error, deviated angle at the first and final visits, and the results of refraining from smartphone use, use of the Fresnel prism, and surgery for esotropia. RESULTS: A total of 13 patients were studied, including 8 males and 5 females. The mean age at development of esotropia was 22.7 ± 9.7 years. The mean duration of esotropia before the first visit was 28.0 ± 33.0 months, and the mean follow-up period was 16.4 ± 16.4 months. The mean angle of esotropia was 21.8 ± 7.0 prism diopters (PD) at distance and 22.2 ± 7.9 PD at near. There were eight myopic patients; the other patients were emmetropia. The esotropia of all patients did not improve after refraining from smartphone use. There was no improvement in five patients who were wearing the Fresnel prism for ≥ 4 months. A total of six patients were treated with bilateral medial rectus recession; only one patient remained orthotropic at postoperative 6 months, three patients were undercorrected, and two had a recurrence. CONCLUSIONS: Esotropia persisted after refraining from smartphone use or wearing a Fresnel prism in acute acquired comitant esotropia patients who were smartphone overusers, and the surgical prognosis of these patients was relatively poor.

Health-related quality of life and binocular vision in patients with diplopia in acute-onset comitant esotropia with press-on prism improves / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To assess the effect of press-on prisms in patients with acute-onset comitant esotropia and diplopia,focusing primarily on vision-related quality of life and binocular vision.METHODS:Retrospective case-series study.Totally 16 acute-onset comitant esotropia patients with diplopia who received treatment in the Huzhou Central Hospital were included in this study from March 2014 to March 2017.Vision-related quality of life before press-on prism correction and 1mo after press-on prism correction were performed with the Chinese version of the 25-item National Eye Institute Visual Functioning Questionnaire (CHI-NEI-VFQ-25).In each time of follow-up,we made a minute examination,includes worth four dot test and stereo tests.Data was statistically analyzed with paired sample t test,Chi-square test and Fisher's exact test.RESULTS:Except the degree of eye pain,color vision and perimetry,the indicators from CHI-NEI-VFQ-25 table including general health status,overall vision,mental health,social role difficulties,social functional,near activities,distant activities,independency and driving of acute-onset comitant esotropia patients with diplopia were obviously significant improved 1 mo after press-on prism correction (P＜0.05).One month after press-on prism correction,the fusion function and stereo acuity were significant enhanced (P＜0.05).CONCLUSION:Press-on prism correction may be helpful for binocular vision recovery in acute-onset comitant esotropia patients with diplopia,so as improve the vision-related quality of life.

Acute Comitant Esotropia in a Child With a Cerebellar Tumor

We report a case of acute comitant esotropia in a child with a cerebellar tumor. A 3-year-old boy was referred for management of a 9 month history of acute acquired comitant esotropia. On first presentation, the patient's angle of esodeviation was 50 prism-diopters (PD) at distance and near fixation without any lateral incomitance. The cycloplegic refraction revealed +0.75 diopters in both eyes. Very mild bilateral papilledema was found on the fundus examination, but the neurological examination did not reveal any other pathological findings. Brain MRI showed a 5 cm mass located in the midline of the cerebellum as well as hydrocephalus. The mass was completely excised and histological examination confirmed the diagnosis of pilocytic astrocytoma. Despite neurosurgery, the patient's strabismus remained unresolved. One year after neurosurgery, both medial rectus muscles were surgically recessed by 6 mm, resulting in esotropia of 8PD at distant and near fixation without restoration of bifoveal fusion at follow-up 2 years after the eye muscle surgery. Therefore, acute onset comitant esotropia in a child can be the first sign of a cerebellar tumor, even without any other neurological signs and symptoms.

Clinical Aspect of Acute Comitant Esotropia

PURPOSE: To evaluate the clinical aspect of acute comitant esotropia and the prognosis for the return of binocular function. METHODS: A clinical study was carried out for all patients who had been diagnosed as acute comitant esotropia with diplopia from July 1987 to April 1994. Each patient underwent a full opthalmological examination including history, family history, refractive error, prism cover test and sensory evaluation. RESULTS: Sixteen patients met the inclusion criteria. Ages of these patients ranged from 5 to 46 years. Three patients with history of occlusion were Swan type (type I), 5 patients without history of occlusion were Franceschetti type (type II) and 8 patients with myopia were Bielschowsky type (type III). Fifteen patients were treated with strabismus surgery and 12 patients restored binocular function. CONCLUSIONS: Acute comitant esotropia developed mostly over 5 year-old age and can be classified as three types. If the patient has no apparent cause for acute comitant esotropia, the underlying neurologic disorder should be considered. When orthophoria is achieved by strabismus surgery, the prognosis of binocular function is expected to be good.

Two Cases of Acute Acquired Comitant Esotropia after Occlusion Therapy

PURPOSE: To describe the new type of acute comitant estropia with dual cause of fusional dysfunction due to occlusion and refractive-accommodative factors. METHODS: We experienced two case of acute, acquired comitant esotropia in the course of occlusion therapy. The patients had mild hyperopia and severe accommodative tendency. RESULTS: After strabismus surgery, the patients have orthophoria and stereopsis recovery. CONCLUSIONS: We believe that the patients with acute comitant esotropia and abrupt diplopia should undergo thorough ophthalmological, neurological evaluations. And, acute comitant esotropia might occur during the occlusion therapy for amblyopia.