Clinical characteristics and surgical outcomes of acute acquired Comitant Esotropia

Abstract

Background To describe the clinical characteristics and the outcomes of strabismus surgery for acute acquired comitant esotropia (AACE). Methods Medical records of 45 AACE patients were retrospectively analyzed. The insertion location of medial rectus was compared between the AACE patients and comitant exotropic patients. The location was also compared with those measured in other studies. Surgical outcome measurements included amount of deviation and level of binocularity at last follow-up. Results The distance from medial rectus to limbus was shorter in AACE patients than in patients with comitant exotropia. The distance was also shorter in AACE patients than patients in other studies. Out of the 45 patients, 2 had neurological diseases. Neostigmine test was negative in all patients. The age at onset of AACE was 5–47 years (mean 19.1 ± 7.3 years), one patient was 5 years (2.2%), 20 patients were 11–17 years (44.5%) and the other 24 patients were 18–47 years old (53.3%). The mean cycloplegic refraction was − 4.1 ± 3.0 diopters (D) and 41 patients were myopic (91%). The angle of deviation was 40.5 ± 19.5 prism diopters (PD) at distance and 35.6 ± 19.9PD at near preoperatively. The angle was 0.8 ± 1.6 PD at distance and 0.7 ± 1.8 PD at near postoperatively. Diplopia resolved in patients who underwent strabismus surgery, with no recurrence during the follow-up period. Thirty patients had stereopsis postoperatively. Conclusions AACE seems to occur mostly in older children and adults and myopes. The distance from the insertion to limbus of medial rectus was shorter in patients with AACE. Good results can be achieved by strabismus surgery.

Treatment of Acute Acquired Concomitant Esotropia

“…Excessive near work appeared to be an important risk factor for AACE in patients > 14 years of age; among the population included in our study, the average time devoted to near work was 11.4 ± 2.48 hours per day. This value is similar to those reported previously [2,4,5]. Mental stress may also be involved in the occurrence of esotropia.…”

“…The incidence rate of acute acquired concomitant esotropia has increased dramatically, especially in Asian countries [1][2][3][4][5]. There are various treatments for AACE, includes extraocular muscle surgery, botulinum toxin injection, prisms, and divergence training.…”

Comparison of the therapeutic effects of surgery following prism adaptation test versus surgery alone in acute acquired comitant esotropia

“…All patients underwent routine ophthalmologic examinations (refraction, visual acuity, outer eye, anterior segment, fundus), head computed tomography (CT) or magnetic resonance imaging (MRI). As descripted previously, AACE was classified into Swan type, Burian-Franceschetti type and Bielschowsky type [ 2 , 3 ]. The accommodative convergence/accommodation (AC/A) ratio was measured with the gradient method preoperatively to check for accommodative esotropia.…”

“…Acute acquired comitant esotropia (AACE) is a rare type of esotropia that usually occurs in older children and adults [ 1 ]. It is classified into three types: 1) Swan type: esotropia due to monocular occlusion or loss of vision in one eye; 2) Burian-Franceschetti type: esotropia characterized by minimal hypermetropia and diplopia, often associated with physical or psychological stress; 3) Bielschowsky type: esotropia in patients with varying degrees of myopia, and shows equal deviation at near and distance fixation [ 2 , 3 ]. Its clinical characteristics include an acute onset of comitant esotropia with diplopia (same deviation in all gaze direction), normal ocular motility, recessive, constant or intermittent esotropia, and a certain binocular visual function [ 4 , 5 ].…”

“…Its clinical characteristics include an acute onset of comitant esotropia with diplopia (same deviation in all gaze direction), normal ocular motility, recessive, constant or intermittent esotropia, and a certain binocular visual function [ 4 , 5 ]. The current treatment strategies are surgery, botulinum toxin injection and prescription of prism glasses [ 3 , 6 , 7 ]. Botulinum toxin has been used to diagnose and treat different types of strabismus since the 1970s [ 8 ].…”