RESUMEN
PURPOSE: This study aimed to observe the clinical characteristics of acute acquired concomitant esotropia (AACE) patients in recent five years and to examine the changes in the proportion of AACE cases before and after the COVID-19 pandemic. METHODS: A retrospective study included 148 patients who underwent strabismus correction surgery for AACE between January 1, 2017, and December 31, 2021. The study analyzed the changing proportion of AACE cases before and after the COVID-19 pandemic and analyzed its clinical characteristics. RESULTS: Abnormalities in the worth 4 dot examination (both distance and near) were present in 134 cases (90.54%) before surgery, while 140 cases (94.59%) showed normal results after surgery. Near stereoacuity was present in 135 cases (91.22%). The near and distance deviations were (55.01 ± 18.77) PD and (57.30 ± 17.64) PD, respectively, and there was no significant difference between the two (p = 0.279). There were significant differences in the ratio of refractive status among different age groups (p < 0.001), while no statistically significant difference was observed in the ratio of refractive status for near deviation (p = 0.085) or distance deviation (p = 0.116). The proportion of AACE cases after the COVID-19 pandemic was significantly higher than that before the COVID-19 pandemic (p = 0.042). There was no statistically significant difference in the clinical characteristics between the two groups (p > 0.05). CONCLUSIONS: Myopia is the most common refractive status in AACE. More than half of patients had occupations that involved long hours of close work. The proportion of AACE cases increased significantly after the COVID-19 pandemic.
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COVID-19 , Esotropía , SARS-CoV-2 , Humanos , COVID-19/epidemiología , Estudios Retrospectivos , Esotropía/fisiopatología , Esotropía/epidemiología , Esotropía/cirugía , Masculino , Femenino , Persona de Mediana Edad , Adulto , Enfermedad Aguda , Niño , Adolescente , Músculos Oculomotores/cirugía , Músculos Oculomotores/fisiopatología , Agudeza Visual/fisiología , Procedimientos Quirúrgicos Oftalmológicos , Anciano , Adulto Joven , Preescolar , Pandemias , Visión Binocular/fisiologíaRESUMEN
BACKGROUND/OBJECTIVES: A national study was undertaken through the British ophthalmology surveillance unit (BOSU) to determine the incidence, presenting features and management of essential infantile esotropia (EIE) in the UK. METHODS: Data from a prospective national observational study of newly diagnosed EIE presenting to clinicians in the United Kingdom over a 12-month period were collected. Cases with a confirmed diagnosis by a clinician of a constant, non-accommodative esotropia ≥20 prism dioptres (PD), presenting at ≤12 months, with no neurological or ocular abnormalities were identified through BOSU. Follow-up data were collected at 12 months. RESULTS: A total of 57 cases were reported giving an incidence of EIE of 1 in 12,828 live births. The mean age of diagnosis and intervention were 7.05 ± 2.6 months (range 2-12) and 14.7 ± 4.9 months (range 6.5-28.1), respectively. Management was surgical in 59.6%, botulinum toxin alone in 22.8%, and 17.5% were observed. The preoperative angle of esotropia was smaller in the observation group (P = 0.04). The postoperative angle of esotropia was not statistically significant between botulinum toxin or surgery (P = 0.3), although the age of intervention was earlier in the botulinum group (P = 0.007). Early intervention (before 12 months of age) did not influence the post-intervention motor outcomes between 0 and 10 prism dioptres of esotropia (P = 0.78). CONCLUSIONS: The incidence of EIE in the UK is considerably lower than reported in other population-based studies. The preferred method of treatment was surgical with earlier intervention in those treated with botulinum toxin. An early age of intervention (<12 months) did not influence motor outcomes.
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Toxinas Botulínicas Tipo A , Esotropía , Oftalmología , Humanos , Lactante , Esotropía/diagnóstico , Esotropía/epidemiología , Esotropía/terapia , Toxinas Botulínicas Tipo A/uso terapéutico , Incidencia , Estudios Prospectivos , Visión Binocular , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos , Resultado del Tratamiento , Reino Unido/epidemiología , Estudios RetrospectivosRESUMEN
BACKGROUND/OBJECTIVES: We investigated the clinical features and change in incidence of AACE in South Korea. SUBJECTS/METHODS: We reviewed the medical records of AACE patients who visited the Strabismus Clinic of at a tertiary referral hospital from 2007 to 2021. Clinical features were retrieved, including age at onset, angle of deviation, refractive errors, neuroimaging findings, and treatment outcomes. For each year, the proportion of new AACE patients among all new patients who visited the clinic, and the ratio of new AACE patients to new intermittent exotropia (IXT) patients, were analysed to estimate the incidence of AACE. RESULTS: Overall, 59 patients were included in the study. The mean age of the patients was 24.7 ± 9.3 years; the incidence of AACE was highest in teenagers and young adults. No patients had a history of visual occlusion, recent physical or psychological stress, or uncorrected myopia, unlike to classic AACE; moreover, no patients exhibited abnormalities in neuroimaging. There was a significantly increasing trend in the proportion of new AACE patients among all new patients (linear regression analysis, R2 = 0.778, p < 0.001). There was also a significantly increasing trend in the ratio of new AACE patients to new IXT patients (R2 = 0.803, p < 0.001). CONCLUSIONS: A new type of AACE, distinct from the classic types, is increasingly common in South Korea; this increasing incidence also appears to be a global phenomenon. Large-scale investigations are needed to define the exact clinical features, incidence, and pathophysiology of this new type of AACE.
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Esotropía , Humanos , República de Corea/epidemiología , Incidencia , Masculino , Femenino , Adolescente , Esotropía/epidemiología , Esotropía/fisiopatología , Adulto , Adulto Joven , Estudios Retrospectivos , Niño , Enfermedad Aguda , Persona de Mediana Edad , Preescolar , Músculos Oculomotores/fisiopatología , Agudeza Visual/fisiologíaRESUMEN
The study aimed to assess the risk of reoperations for strabismus in the pediatric population and to identify high-risk groups. This was a nationwide population-based study that used data from the Korean National Health Claims Database from 2008 to 2020. Two major cohorts were established based on initial strabismus: age-, sex-, and recruitment year-matched controls were randomly selected. Patients aged ≤ 9 years who underwent initial strabismus surgery for exotropia and esotropia were included, resulting in a total of 24,816 patients included to this study. The cumulative incidence of reoperations was 843 per 10,000 persons for exotropia, 1559 per 10,000 persons for esotropia. To assess the significant exposure factors, conditional logistic regression was performed to obtain odds ratio (OR) in each cohort. In patients with exotropia, the OR of reoperations was 4.26 times higher when the initial surgery is performed at younger age (earlier than 3-year-old) and 6.49 times higher when only one eye underwent than two eye. Similarly, in patients with esotropia, younger age (6.57 times) and unilateral surgery (7.20 times) were identified as common factors that increase the risk of reoperations. Based on the findings, special attention is recommended for patients younger than 3 years, especially those performed unilateral surgery as initial intervention in practical settings.
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Esotropía , Exotropía , Estrabismo , Humanos , Niño , Preescolar , Esotropía/cirugía , Esotropía/epidemiología , Exotropía/cirugía , Reoperación , Estudios de Casos y Controles , Estrabismo/cirugía , Estudios RetrospectivosRESUMEN
PURPOSE: To analyze epidemiology, clinical features, and surgical outcomes of type III acute acquired concomitant esotropia (Bielschowsky esotropia (BE)). METHODS: The medical charts of patients diagnosed with acquired concomitant esotropia between 2013 and 2021 were reviewed. Assessed data were age, gender, age at diplopia onset, age at the diagnosis, refraction, visual acuity, neuroimaging, diplopia onset, angle of deviation, stereopsis, surgical procedure, amount of surgery, and relapse of diplopia after surgery. Moreover, we investigated the correlation between the use of electronic devices and the onset of diplopia. RESULTS: One hundred seventeen patients (mean age 35.07 ± 15.81 years) were included in the study. The mean delay to the diagnosis was 3.29 ± 3.62 years. Myopia range was 0 to 17 diopters spherical equivalent. 66,3% spent more than 4 hours a day using laptops, tablets, or smartphones at the onset of diplopia, and 90,6% presented a subacute onset. None showed neurologic signs or symptoms. Patients who underwent surgery were ninety-three, with a rate of surgical success of 93.6%, and a relapse rate of 17.2%. A negative correlation resulted between pre-operative deviation and age at diagnosis (ρ = -0.261; p<0.05), whereas factors associated with surgical failure were older age at diplopia onset (p = 0.042) and longer delay between onset and diagnosis (p = 0.002). CONCLUSION: We registered an outstanding increase in prevalence of BE, which could be related to the exponential increase in the use of electronic devices for professional, educational, and recreational purposes. A prompt diagnosis and an augmented dose of surgery allows good motor and sensory results.
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Esotropía , Miopía , Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Esotropía/epidemiología , Esotropía/etiología , Esotropía/cirugía , Diplopía/epidemiología , Diplopía/etiología , Diplopía/cirugía , Músculos Oculomotores/cirugía , Estudios Retrospectivos , Procedimientos Quirúrgicos Oftalmológicos/métodos , Miopía/complicaciones , Miopía/epidemiología , Miopía/cirugía , Enfermedad Aguda , Recurrencia , Resultado del TratamientoRESUMEN
BACKGROUND: Age-related distance esotropia (ARDE), is an acquired, small, comitant esodeviation that is greater at distance than at near. It occurs in older adult patients without a history of neurological event or prior strabismus. It has been observed more frequently in White adults than in other racial groups. The purpose of this study was to assess the demographic and clinical characteristics of patients with ARDE presenting at a tertiary neuro-ophthalmology clinic. METHODS: In this retrospective study, ICD-9/10 (ICD-9 378.85 and ICD-10 H51.8) codes were used to identify all patients with ARDE from 2005 to 2020 seen in a single tertiary neuro-ophthalmology clinic. ARDE was defined as esotropia greater at distance than near with associated clinical signs of adnexal tissue laxity. Patients with history or findings compatible with other etiologies of strabismus, such as thyroid eye disease, neuromuscular disorders, sensory deviations, sudden onset of diplopia, and high myopia, as well as those with prior strabismus surgery, were excluded. RESULTS: A total of 89 patients (59 females [66%]) met inclusion criteria. Mean patient age was 76.6 years. All patients were White except for a single patient of African descent. Mean follow-up time was 25.2 months. Mean esodeviation at distance on presentation was 6.6Δ. Of the 87 patients electing nonsurgical treatment, 80 achieved remission of diplopia symptoms with prism therapy alone. Of the 89 patients, 59 had no neuroimaging. CONCLUSIONS: ARDE in our neuro-ophthalmology clinic population was diagnosed almost exclusively in older White adults. Prism therapy was effective for a majority of our patients.
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Esotropía , Estrabismo , Femenino , Humanos , Anciano , Esotropía/diagnóstico , Esotropía/epidemiología , Esotropía/terapia , Diplopía , Estudios Retrospectivos , Estrabismo/complicaciones , DemografíaRESUMEN
PURPOSE: The number of patients with acute acquired comitant esotropia (AACE) has been increasing in Japan. The purpose of this study was to investigate the changes in the number and characteristics of patients with AACE examined in our institution during a 12-year period. METHODS: We retrospectively reviewed the medical records of patients with AACE aged < 30 years who suddenly developed diplopia or esotropia and were examined in Hyogo College of Medicine Hospital from January 2008 to December 2021. We investigated the association of the yearly changes in the number of patients with the age category, refractive error category, AACE type, esotropia type, and use or nonuse of smartphones. RESULTS: The total number of patients with AACE was 171, and this number significantly increased each year (Pearson correlation coefficient, 0.9450; p < 0.0001). Significant increases were found among students in junior high school and beyond, patients with myopia, patients with Bielschowsky type AACE, and patients with basic esotropia (p < 0.0001 for all). We compared two age groups, elementary school students and below versus junior high school students and above, and found that the rate of increase was significantly higher in the junior high school students and above (estimate, 1.951; p < 0.0001), and the non-myopia group and myopia group and found that the rate of increase was significantly higher in the myopia group (estimate, 1.891; p < 0.0001). Excessive use of smartphones was confirmed in 82 of 133 patients, and the rate of the increase in the number of patients with AACE was significantly greater among patients with than without excessive use of smartphones (estimate, 1.098; p = 0.0009). CONCLUSION: This study confirmed a significant increase in the number of patients with AACE in recent years. The excessive use of smartphones may be associated with the increase in AACE.
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Esotropía , Miopía , Errores de Refracción , Humanos , Esotropía/epidemiología , Estudios Retrospectivos , Enfermedad Aguda , Músculos OculomotoresRESUMEN
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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Esotropía , Estrabismo , Adulto Joven , Humanos , Esotropía/epidemiología , Esotropía/etiología , Estudios Retrospectivos , Estudios de Casos y Controles , Estrabismo/epidemiología , Estrabismo/etiología , Visión Binocular , Enfermedad Aguda , Factores de Riesgo , Músculos OculomotoresRESUMEN
SIGNIFICANCE: This study investigated the potential perinatal risk factors associated with infantile esotropia in a Chinese population, including advanced parental age at childbirth and mode of delivery. The findings may be significant in developing better intervention strategies for infantile esotropia. PURPOSE: This study aimed to investigate the associations between gestational age, birth weight, parental age at childbirth, mode of delivery, family history of strabismus, and infantile esotropia in the Chinese population. METHODS: Ninety-nine patients with infantile esotropia and 117 control subjects were enrolled between March 2018 and March 2021. Detailed questionnaires were administered to parents to collect relevant information. Univariate and multivariate logistic regression models were used to identify possible risk factors of infantile esotropia. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS: Infantile esotropia was associated with low birth weight (<2500 g; OR, 4.235; 95% CI, 1.460 to 12.287; P = .008) and emergency cesarean delivery (OR, 2.230; 95% CI, 1.127 to 4.413; P = .02). CONCLUSIONS: The findings suggest that low birth weight and emergency cesarean deliveries are risk factors for infantile esotropia, highlighting a need for collaborative care between obstetricians, pediatricians, and vision care providers.
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Esotropía , Estrabismo , Embarazo , Femenino , Humanos , Esotropía/epidemiología , Edad Gestacional , Peso al Nacer , Estrabismo/complicaciones , PadresRESUMEN
Purpose: To study the profile, risk factors, and management outcomes of infantile strabismus at a tertiary eye care center. Methods: We prospectively analyzed the data of infants (children less than 1 year of age) who presented at our institute from August 2018 to December 2019. We excluded infants who did not complete a minimum follow-up of 6 months. Detailed meticulous history based on a set of standardized questionnaires was obtained and a comprehensive ophthalmological examination of the child was performed. Data were collected regarding refractive error (astigmatism; myopia; hyperopia; anisometropia [<1.0 DS or >1.0 DS]; astigmatism [<1.0 DS or >1.0 DS]) and the type of strabismus. Results: During this period, we saw 4,773 infants, out of which 123 infants were diagnosed to have infantile-onset strabismus (hospital prevalence of 2.6%). Boys and girls were equally affected. Sixty-two patients had esotropia, 37 had exotropia, 2 had hypotropia, and 22 had pseudo strabismus. Prematurity, hypermetropia, and anisometropia had increased odds of developing esotropia, whereas delivery by cesarean section, delayed cry at birth, infantile seizures, parental consanguinity, delayed development of milestones, and myopia had increased odds of developing exotropia. Twenty-nine patients underwent a surgical correction. The mean deviation at the first visit was 42.59 ± 15.40 PD and 8.25 ± 12.70 PD at the last visit. For all patients who underwent a squint surgery, the change in ocular deviation was clinically and statistically significant (P-value <0.0001, paired t-test). Conclusion: The hospital prevalence of infantile strabismus in our cohort was found to be 2.6%. Our study suggests that esotropia is two-fold more common in our cohort as compared to exotropia. Further, our study highlights risk factors for the development of strabismus in infancy, which must be kept in mind and awareness must be created among pediatricians. Surgical correction should be considered early during the infantile period, because it may lead to promote the development of good binocular vision.
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Anisometropía , Astigmatismo , Esotropía , Exotropía , Hiperopía , Miopía , Estrabismo , Cesárea , Niño , Esotropía/diagnóstico , Esotropía/epidemiología , Esotropía/cirugía , Exotropía/diagnóstico , Femenino , Humanos , Hiperopía/diagnóstico , Hiperopía/epidemiología , Recién Nacido , Masculino , Embarazo , Estudios Retrospectivos , Estrabismo/diagnóstico , Estrabismo/epidemiologíaRESUMEN
Age-related distance esotropia (ARDET) is characterized by an esodeviation greater at distance than near in older aged patients and generally managed with prism spectacles or surgery. The purpose of this study is to describe the prevalence, clinical characteristics, and natural history of age-related distance esotropia in a defined population. The medical records of all adult (≥19 years of age) residents of Olmsted County, Minnesota, diagnosed with an esodeviation at least 2 prism diopters (PD) greater at distance than near, from 1 January 1985, through 31 December 2004, were retrospectively reviewed. Seventy-three (9.7%) of 751 new cases of adult-onset strabismus were diagnosed with age-related distance esotropia during the 20-year period. The mean age of onset was 70 years (range, 19 to 93 years) and 48 (65.8%) were female (p = .007). The mean angle of esodeviation was 7.6 (range, 2 to 20) prism diopters (PD) at distance and 0.4 (range, 10 PD of XT to 12 PD of ET) PD at near. The Kaplan-Meier rate of progression, as defined by a ≥ 6 prism diopter (PD) increase in esotropia, was 50% by 15 years after diagnosis. Half of the patients had hypertension, while one-third had coronary artery disease or other cardiac comorbidities. Age-related distance esotropia comprised 1 in 10 adults with new-onset strabismus in this population and was significantly more common among women. Hypertension and cardiovascular disease may be risk factors for this form of strabismus, and approximately half of the patients worsened over a 15-year period.
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Esotropía , Hipertensión , Adulto , Femenino , Humanos , Adulto Joven , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Masculino , Músculos Oculomotores/cirugía , Estudios Retrospectivos , Esotropía/epidemiología , Esotropía/terapia , Hipertensión/cirugía , Factores de Riesgo , Resultado del Tratamiento , Procedimientos Quirúrgicos OftalmológicosRESUMEN
PURPOSE: This study aimed to identify the characteristics of acute acquired comitant esotropia (AACE) in young patients from a single institution; and clarify their relationship with the excess use of digital devices. STUDY DESIGN: Retrospective, observational. METHODS: We extracted the clinical charts of patients aged between 5 and 35 years who presented at the Hamamatsu University Hospital with AACE symptoms from January 1, 2015 to December 31, 2018. The age of onset, angle of deviation, refractive errors, history of near work, including excess smartphone use, and treatment modality were retrieved. Patients were divided into three groups: CHILD (aged 5-12 years), JUNIOR (aged 13-17 years), and ADULT (aged 18-35 years) and statistically analyzed with Kruskal-Wallis test. RESULTS: Forty-one patients were retrieved, with a mean age at onset of 15.8 (5-28) years; eight in the CHILD group, 23 in the JUNIOR group, and 10 in the ADULT group. Refractive errors and age of patients were correlated, but were not significantly different among groups. The mean angle of deviation at distance was 28.0 ± 12.8 prism diopters (PD) and 28.6 ± 17.2 PD at near. The CHILD group showed the largest near-distant dissociation. History of excessive near work was found in all groups. CONCLUSION: AACE was most commonly found in the JUNIOR group, especially those aged 15-16 years. AACE may encompass multiple diseases; using common diagnostic criteria and asking common questions regarding digital device usage is necessary to clarify the influence of digital device usage, and a multicenter prospective study is recommended.
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Esotropía , Errores de Refracción , Enfermedad Aguda , Adolescente , Adulto , Niño , Preescolar , Esotropía/diagnóstico , Esotropía/epidemiología , Humanos , Músculos Oculomotores , Estudios Prospectivos , Estudios Retrospectivos , Adulto JovenRESUMEN
PURPOSE: To investigate the changes in refractive status of amblyopic patients with partially refractive esotropia (PAET). MATERIALS AND METHODS: Amblyopic patients with PAET were enrolled. Non-amblyopic patients with full refractive accommodative esotropia (RAET) were included in the study as a control group. Preoperative and postoperative best-corrected visual acuity (BCVA), spherical equivalent (SE), astigmatism, stereoacuity, and deviations at near and distance were evaluated and statistically compared within the study group. Mean BCVA, SE, astigmatism were compared between the two groups. RESULTS: The patient and the control groups were composed of 58 eyes of 29 patients per group. There were statistically significant differences between pre- and postoperative mean astigmatism and SE between the patient and control groups. The mean astigmatism was higher in amblyopic eyes when compared with the eyes in the control group (P:0.009). During the follow-up period, changes in SE and astigmatism were not different between groups. CONCLUSION: The mean SE and astigmatism were changed in both amblyopic patients with PAET and non-amblyopic patients with RAET during the follow-up period. This suggested that neither amblyopia nor strabismus surgery has an effect on refractive status in patients with PAET.
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Ambliopía , Esotropía , Ambliopía/complicaciones , Ambliopía/epidemiología , Esotropía/complicaciones , Esotropía/epidemiología , Humanos , Refracción Ocular , Estudios Retrospectivos , Pruebas de Visión , Agudeza VisualRESUMEN
PURPOSE: To document the increasing incidence of divergence insufficiency (DI) esotropia and to identify risk factors for DI. METHODS: All patients with a diagnosis of esotropia seen by one provider (DLG) over 41 years were identified from the medical record. Patients with onset of strabismus before age 10 years or with prior strabismus surgery were excluded. Cases of esotropia associated with thyroid eye disease, scleral buckles, trauma, neurological diseases, or atypical misalignment were included but not labeled as DI regardless of the distance versus near deviation. The remaining patients, whatever the original diagnosis, were retrospectively categorized as having, or not having, DI, using a uniform criterion: distance esotropia ≥5Δ more than near esotropia. RESULTS: The percentage of DI patients among acquired esotropia patients increased significantly between the first and second half of the 41-year period, from 11.8% to 29.4% (P < 0.001). Multivariate logistic regression identified advancing age and the use of progressive addition lenses as risk factors for the development of DI. CONCLUSIONS: The incidence of DI is increasing. DI's association with age and progressive addition lenses may help us to understand its etiology and to decrease the prevalence of this condition in the future.
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Esotropía , Estrabismo , Niño , Esotropía/epidemiología , Esotropía/cirugía , Humanos , Incidencia , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Extra time of sitting in front of a digital device is required for e-learning by children during Corona virus (COVID-19) pandemic which can lead to many ocular problems including digital eye strain (DES). In view of increased incidence of DES in children, multiple studies had been conducted in central India to assess the eye strain in children due to excessive online classes as a research project named "Digital eye strain among kids (DESK) study." This study DESK-3 aimed to report series of cases of acute acquired comitant esotropia (AACE) in children attending online classes during COVID-19 pandemic. Children aged 6-18 years with recent onset of esotropia of < 1-month duration without any similar history in past presented in month of July-August 2020 at a tertiary children eye care hospital were evaluated. Data collection included age and gender of child, presence or absence of diplopia, visual acuity, duration of smartphone use, duration of online classes, angle of deviation for near and distance and cycloplegic refraction. Total eight children of AACE were included in the study. The mean age of children was 12.5 ± 4.2 years. All eight were males. The mean duration of smartphone use was 4.6 + 0.7 hours per day. All children were attending online classes > 4 hours per day on smartphone of average size 5.5 inches. Five children were emmetropic, one myopic, one pseudomyopic and one hyperopic. The angle of deviation for near and distance were 48.1 ± 16.4 PD and 49.3 ± 15.9 PD respectively with normal ocular motility. Seven children complained of horizontal diplopia in all gazes. Neurological examination and CT scan of brain and orbit was normal in all patients. Two months before the lockdown only one case was identified as compared to eight during the lockdown. Prolonged near work during smart phone use for e-learning might lead to the development of AACE in children.
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COVID-19 , Esotropía , Adolescente , Niño , Control de Enfermedades Transmisibles , Esotropía/epidemiología , Esotropía/etiología , Humanos , Masculino , Pandemias , Estudios Retrospectivos , SARS-CoV-2 , Teléfono InteligenteRESUMEN
The study aims to determine the prevalence of strabismus and its risk factors among school children in Hong Kong. This is a cross-sectional study involving 6-8 year old children from different districts in Hong Kong. 4273 children received comprehensive ophthalmological examination, cycloplegic auto-refraction, best corrected visual acuity (BCVA), anterior segment examination, cover/uncover test, ocular motility, and fundus examination. Demographic information, pre- and post- natal background, parental smoking status, and family history of strabismus were obtained through questionnaires. Strabismus was found among 133 children (3.11%, 95% CI 2.59-3.63%), including 117 (2.74%) exotropia and 12 (0.28%) esotropia cases (exotropia-esotropia ratio: 9.75:1). There was no significant difference in prevalence across age (6-8 years) and gender. Multivariate analysis revealed associations of strabismus with myopia (≤ - 1.00D; OR 1.61; 95% CI 1.03-2.52; P = 0.037) hyperopia (≥ + 2.00D; OR 2.49; 95% CI 1.42-4.39; P = 0.002), astigmatism (≥ + 2.00D; OR 2.32; 95% CI 1.36-3.94; P = 0.002), and anisometropia (≥ 2.00D; OR 3.21; 95% CI 1.36-7.55; P = 0.008). Other risk factors for strabismus included maternal smoking during pregnancy (OR 4.21; 95% CI 1.80-9.81; P = 0.001), family history of strabismus (OR 6.36; 95% CI 2.78-14.50, P < 0.0001) and advanced maternal age at childbirth (> 35 years; OR 1.65; CI 1.09-2.49, P = 0.018). The prevalence of strabismus among children aged 6-8 years in Hong Kong is 3.11%. Refractive errors, family history of strabismus and maternal smoking history during pregnancy are risk factors. Early correction of refractive errors and avoidance of maternal smoking during pregnancy are potentially helpful in preventing strabismus.
Asunto(s)
Anisometropía/epidemiología , Esotropía/epidemiología , Exotropía/epidemiología , Estrabismo/epidemiología , Anisometropía/diagnóstico , Anisometropía/diagnóstico por imagen , Anisometropía/patología , Niño , Esotropía/diagnóstico , Esotropía/diagnóstico por imagen , Esotropía/patología , Exotropía/diagnóstico , Exotropía/diagnóstico por imagen , Exotropía/patología , Femenino , Hong Kong/epidemiología , Humanos , Masculino , Refracción Ocular/fisiología , Errores de Refracción/diagnóstico , Errores de Refracción/diagnóstico por imagen , Errores de Refracción/epidemiología , Errores de Refracción/fisiopatología , Factores de Riesgo , Estrabismo/diagnóstico , Estrabismo/diagnóstico por imagen , Estrabismo/patología , Pruebas de Visión , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: High myopic patients may develop strabismus due to globe dislocation out of the normal extraocular muscle cone. Surgical correction of this strabismus type is possible by joining the superior and lateral rectus muscles without the need for a scleral suture called the Yokoyama procedure. Data from large patient samples and the evaluation of a potential effect of an additional medial rectus recession (MRR) have been lacking so far. METHODS: We pooled retrospective patient data of 14 departments of ophthalmology in Germany and Switzerland and analysed determinants of postoperative results using multivariable regression models. RESULTS: We included 133 patients (mean age: 59.7 ± 13.4 years, surgery between 2008 and 2017) with a mean preoperative esotropia (both Yokoyama with and without MRR) of 23.8°±4.6°. The angle of preoperative esotropia increased with age. The postoperative esotropia was 8.7° ± 9.9°, and six patients were overcorrected. While preoperative esotropia was highly associated with postoperative results, we found no association of additional MRR with any of our postoperative outcome measures. The Yokoyama procedure had a higher absolute effect in patients with higher preoperative esotropia. CONCLUSION: Our study confirms the positive effect of the Yokoyama procedure on strabismus due to high myopia in large-scale real-world data. In some cases, MRR may be needed because of muscle contracture, although additional MRR statistically did not affect the postoperative outcome. In patients with bilateral high myopic strabismus, correction of both eyes seems beneficial. The effect size of the Yokoyama procedure appears to be mainly driven by preoperative esotropia.
Asunto(s)
Esotropía/cirugía , Miopía/complicaciones , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodos , Refracción Ocular/fisiología , Esclerótica/cirugía , Visión Binocular/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biometría , Esotropía/epidemiología , Esotropía/etiología , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Miopía/fisiopatología , Estudios Retrospectivos , Técnicas de Sutura , Suiza/epidemiología , Adulto JovenRESUMEN
Purpose: To investigate risk factors predisposing to the failure of nonsurgical treatment of consecutive esotropia.Methods: A retrospective review was carried out for all cases diagnosed as having developed consecutive esotropia who following surgical correction of intermittent exotropia between 2013 and 2018 and have failed to conservative treatment. Performing 1:2 case-control match, control subjects were randomly selected from patients who underwent surgeries for intermittent exotropia during the same period but did not develop consecutive esotropia. Various factors were examined for assessing the risks for the failure of nonsurgical intervention in the treatment of consecutive esotropia.Results: A total of 270 patients were enrolled in the study. Ninety cases were diagnosed as consecutive esotropia and 180 as controls. Univariate analysis showed significant association of consecutive esotropia for ineffective nonsurgical treatment with age of the patient at the onset of exotropia, age of the patient at the time of surgery, amblyopia, preoperative deviation, the type of surgical procedure, and the vertical components combined with exotropia (p<0.01).To further explore potential risk factors of consecutive esotropia, conditional logistic regression model was applied. Patients aged below 3 years old at the time of surgery and bilateral lateral rectus recession were shown in conditional logistic regression analysis to be significantly associated with higher incidence of consecutive esotropia (p<0.01).Conclusion: The presence of an early age (below 3 years old) at surgery and bilateral symmetric procedure may be associated with a high risk of consecutive esotropia who failed with conservative therapy. Systematic preoperative examination, close supervision, suitable surgical approach could be optimized to reduce the risk of consecutive esotropia.
Asunto(s)
Esotropía/cirugía , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodos , Edad de Inicio , Ambliopía/fisiopatología , Niño , Preescolar , Tratamiento Conservador , Percepción de Profundidad/fisiología , Esotropía/epidemiología , Esotropía/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Músculos Oculomotores/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Insuficiencia del Tratamiento , Visión Binocular/fisiología , Agudeza Visual/fisiologíaRESUMEN
BACKGROUND: Infantile esotropia is characterized by a significant deviation angle and a marked sensory perversion. Although the motor surgical results are satisfactory, the sensory results remain disappointing. AIM: Our work aims to describe the methods of surgical management, its motor and sensory results as well as its prognostic factors. METHODS: Retrospective study of 68 cases of infantile esotropia. All patients underwent a complete ophthalmologic examination and sensorimotor assessment. They were operated on, under general anesthesia, by the same surgeon. We assessed the motor and sensory results. The prognostic factors studied were age of onset, treatment delay, amblyopia severity, strabismus deviation angle, and presence of a vertical element. RESULTS: The mean minimum angle of deflection was 38.6 ± 13.2D. Inferior oblique muscle hyper action was noted in 73.5% and a dissociated vertical deviation in 5.8%. Bilateral medial rectus muscle recession was the most performed surgery (60.2% of cases). The overall success rate was 94.11%. No patient acquired stereoscopic vision. Multivariate logistic regression analysis showed that preoperative nail (p = 0.007), immediate postoperative outcome (p <0.001) and surgical dosage (p = 0.009) were associated with long-term motor success. CONCLUSION: The motor results of early esotropia surgery are generally satisfactory; the sensory results are often disappointing. Detecting poor prognostic factors improves operative results.