Characteristics and Surgical Outcomes of Comitant Esotropia in an Adult Population Between 18 and 60 Years Old.

PURPOSE: To describe the clinical characteristics and surgical outcomes of adults with comitant non-accommodative esotropia. DESIGN: Retrospective case series METHODS: Retrospective review of medical records of patients 18 to 60 years old with comitant esotropia who underwent strabismus surgery at a tertiary eye care center between 2014 and 2023. The etiology of esotropia was categorized into three groups based on the disparity between near-distance angles of deviation: 1. basic esotropia (ETBA); 2. esotropia divergence insufficiency pattern (ETDI); or 3. esotropia convergence excess pattern (ETCE). The main outcome measures were strabismus characteristics and motor and sensory surgical outcomes. Surgical motor success was defined as a deviation that measured ≤ 10 prism diopters (PD). RESULTS: Of the 219 that met the inclusion criteria, most patients were female (140, 64%) and had a mean age of 36.7 ± 12.3 years (range 18-60 years). The majority were myopic (157, 72%) and reported diplopia (176/219, 80.3%). The ETCE group had the largest mean deviations at both distance (45.5 ± 11.5 PD) and near (64 ± 12.3 PD) while the ETBA group had the largest ranges at distance (31 ± 13.5 PD, range 3-90) and near (30 ± 15 PD, range 2- 85). Bilateral medial rectus recession (BMR) and unilateral recess-resect (R&R) procedures were performed with equal frequency (both 48%). Motor and sensory success were achieved more often with R&R than BMR, although only motor success was statistically significant (87.8% vs. 73.2%, p=0.0375 and 93.3% vs. 85.5%, p=0. 15 respectively). At the last encounter, 88.1% (119/135) of patients with pre-operative diplopia achieved single binocular vision. CONCLUSIONS: Regardless of the pattern of esotropia, strabismus surgery in adults with comitant non-accommodative esotropia resulted in good motor and sensory outcomes.

Using the White Disk Test to Predict Fusional Potential.

INTRODUCTION: Fusional potential in patients experiencing binocular torsional diplopia may be challenging for the clinician to assess, particularly when accompanied by vertical and horizontal diplopia. OBJECTIVE: To demonstrate a clinical test that may help predict if binocular fusion can be achieved once cyclotorsion is alleviated. DESIGN: Video recording demonstrating how to perform the white disk test and retrospective chart review of patients tested with the white disk test. RESULTS: Twelve patients with binocular torsional diplopia were included. All subjects had excyclotorsion, 11 (91.7%) had combined vertical and horizontal strabismus and 1 patient (8.3%) had vertical strabismus. Eleven patients (91.7%) were able to achieve single binocular vision with the white disk test and 1 patient (8.3%) demonstrated brittle fusion. The white disk test successfully predicted postoperative fusion in 10 of 11 patients (90.9%). Eight patients (66.7%) demonstrated improved stereopsis after surgery. CONCLUSION: The white disk test was found to be very useful in predicting fusional potential in patients that experience binocular torsional diplopia.

Marcus Gunn jaw winking syndrome in a 6-year-old boy: a new observation.

We report the case of a 6-year-old boy with bilateral Marcus Gunn jaw winking syndrome with a left hypotropia in primary gaze that decreased in magnitude during jaw thrust to the contralateral side. To our knowledge, this is a new observation with regard to the ocular motility disturbances in this syndrome.

A novel test for predicting fusional potential in patients with torsional diplopia.

We introduce the novel "white disk" test to evaluate fusional potential in patients with torsional diplopia. In this test, a white disk is presented on a black background in a darkened room to eliminate perception of torsion. Horizontal and vertical misalignment is neutralized with prisms when necessary. The absence of diplopia on the white disk test is used to establish fusional ability. Nine patients with torsional diplopia were assessed using this test. All had excyclotorsion (mean, 9.9° ± 4.2°; range, 5°-15°) and could achieve single binocular vision on testing. Postoperatively, 9 patients reported no torsional diplopia in the preferred gaze position, with a mean excyclotorsion of 0.4° ± 2.8° (range, -5° to 4°). The test appeared to predict fusional potential in all patients.