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Clinical Characteristics and Surgical Effects of Type Ⅲ Acute Acquired Concomitant Esotropia |
Aixia Yao, Chenghu Wang |
The Affiliated Eye Hospital of Nanjing Medical University, Nanjing 210009, China |
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Abstract Objective: To investigate the clinical characteristics and surgical effects in type Ⅲ acute acquired concomitant esotropia (AACE Ⅲ). Methods: This was a retrospective self-control study. Thirty-one AACE Ⅲ patients, aged 14 to 39 years, who underwent routine strabismus surgery at the Affiliated Eye Hospital of Nanjing Medical University, were enrolled from July 2016 to July 2019. The following data were collected: Onset time, binocular ametropia, time of near work, the attachment point of the internal rectus muscle, pre- and postoperative deviation, fusion range, and distance and near stereopsis. The followup period ranged from 6 months to 12 months (7.4±2.6 months). A Wilcoxon signed rank test was used to compare the difference in esodeviation and binocular fusion range before and after strabismus surgery. Preand postoperative distance stereopsis were analyzed by the traditional paired Chi square test, while pre- and postoperative near stereopsis was analyzed by the enhanced paired Chi square test. Results: Among the 31 patients with AACE Ⅲ, 3 patients (10%) had high myopia, 25 patients (81%) had moderate myopia, 2 patients (6%) had low myopia, and only one patient (3%) had emmetropia. All patients had performed nearwork with an average time of 7.8±1.1 hours per day. The average distance between the attachment point of the internal rectus muscle and the corneal limbus was 4.9±0.1 mm. The median pre-operative esodeviation at near (33 cm) was 35 PD, and at distance (6 m) was 40 PD. The difference between them was statistically significant (Z=-3.136, P=0.002). In this study, all patients underwent a successful strabismus operation and at the time of the final follow-up, whether it was at 33 cm or 6 m, the median degree of postoperative strabismus was 0 PD. Compared with the pre-operative degree of strabismus at the same distance, the postoperative degree was significantly smaller (both Z=-4.865, both P<0.001). The median of pre- and postoperative binocular fusion range was 14° and 19°, respectively, and the difference between them was statistically significant (Z=-3.149, P=0.002). Compared with distance and near stereopsis before strabismus surgery, 16(84%) patients recovered distance stereopsis and 19(95%) patients recovered near stereopsis after the surgery. Both distance and near stereopsis significantly improved when comparing stereopsis before and after surgery. The difference was statistically significant (χ2 =14.063, 24.000, respectively; P<0.001, P=0.001, respectively). Conclusions: Prolonged near work, the forward attachment point of the internal rectus muscle and moderate myopia appear to be important risk factors for AACE Ⅲ. Strabismus surgery to establish the proper angle can significantly diminish the degree of esotropia and improve the binocular fusion range and stereopsis in AACE Ⅲ patients.
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Received: 28 February 2020
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Corresponding Authors:
Chenghu Wang, the Affiliated Eye Hospital of Nanjing Medical University, Nanjing 210009, China (Email: wangchenghu1226@163.com)
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[1] |
Clark AC, Nelson LB, Simon JW, et al. Acute acquired comitant esotropia. Br J Ophthalmol, 1989, 73(8): 636-638. DOI: 10.1038/eye.1999.167.
|
[2] |
Mohney BG. Common forms of childhood strabismus in an incidence cohort. Am J Ophthalmol, 2007, 144(3): 465-467. DOI: 10.1016/j.ajo.2007.06.011.
|
[3] |
Sturm V, Menke MN, Knecht PB, et al. Long-term follow-up of children with acute acquired concomitant esotropia. J AAPOS, 2011, 15(4): 317-320. DOI: 10.1016/j.jaapos.2011.03.018.
|
[4] |
Burian HM, Miller JE. Comitant convergent strabismus with acute onset. Am J Ophthalmol, 1958, 45(42): 55-64.
|
[5] |
Lee J. Binocular vision and ocular motility. Br J Ophthalmol, 1991, 75(6): 384-384.
|
[6] |
Lee HS, Park SW, Heo H. Acute acquired comitant esotropia related to excessive Smartphone use. BMC Ophthalmol, 2016, 16: 37. DOI: 10.1186/s12886-016-0213-5.
|
[7] |
Webb H, Lee J. Acquired distance esotropia associated with myopia. Strabismus, 2004, 12(3): 149-155. DOI: 10.1080/09273970490489694.
|
[8] |
易昀敏, 苏明山, 王慧珍, 等. 急性共同性内斜视的研究进展.实用临床医学, 2012, 3(3): 129-131.
|
[9] |
蔡春艳, 覃银燕, 黄华林, 等. 急性共同性内斜视临床特点及病因分析. 中国斜视与小儿眼科杂志, 2017, (1): 31-33. DOI: 10.3969/j.Issn.1005-328x.2017.01.010.
|
[10] |
Meyer E, Ludatscher RM, Lichtig C, et al. End-stage fibrosis of the lateral rectus muscle in myopia with esotropia. An ultrastructural study. Ophthalmic Res, 1990, 22(4): 259-264. DOI: 10.1159/000267032.
|
[11] |
Hoyt CS, Good WV. Acute onset concomitant esotropia: When is it a sign of serious neurological disease? Br J Ophthalmol, 1995, 79(5): 498-501. DOI: 10.1136/bjo.79.5.498.
|
[12] |
Dawson EL, Marshman WE, Adams GG. The role of botulinum toxin A in acute-onset esotropia. Ophthalmology, 1999, 106(9): 1727-1730. DOI: 10.1016/S0161-6420(99)90360-3.
|
[13] |
常枫, 陈云辉, 陈晓, 等. 急性共同性内斜视的临床特点和非手术治疗的疗效评估. 中华眼视光学与视觉科学杂志, 2019, 21(2): 147-152. DOI: 10.3760/cma.j.issn.1674-845X.2019.02. 012.
|
[14] |
Savino G, Colucci D, Rebecchi MT, et al. Acute onset concomitant esotropia: Sensorial evaluation, prism adaptation test, and surgery planning. J Pediatr Ophthalmol Strabismus, 2005, 42(6): 342-348.
|
[15] |
薛颖, 饶惠英, 黄永洁, 等. 急性共同性内斜视手术设计探讨. 创伤与急诊电子杂志, 2017, 5(2): 72-74. DOI: 10.16746/j.cnki. 11-9332/r.2017.02.006.
|
[16] |
Campos EC. Why do the eyes cross? A review and discussion of the nature and origin of essential infantile esotropia, microstrabismus, accommodative esotropia, and acute comitant esotropia. J AAPOS, 2008, 12(4): 326-331. DOI: 10.1016/ j.jaapos.2008.03.013.
|
[17] |
黄晓刚, 杨甜柯, 姚静艳. 成人急性共同性内斜视的临床特征分析. 临床眼科杂志, 2019, 27(1): 70-73. DOI: 10.399/ j.issn.1006-8422.2019.01.020.
|
[18] |
任美玉, 王琪, 王利华. 急性获得性共同性内斜视的临床特征及手术疗效. 中华眼科杂志, 2017, 53(12): 908-916. DOI: 10.3760/cma.j.issn.0412-4081.2017.12.006.
|
|
|
|