Clinical features of acute acquired comitant esotropia in the Chinese populations

Fu, Tao; Wang, Jing; Levin, Moran; Xi, Peng; Li, Dongguo; Li, Junfa

doi:10.1097/md.0000000000008528

Cited by 27 publications

(43 citation statements)

References 21 publications

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“…Adults had higher myopia compared with younger children aged <10 years. These findings are in line with a previous study 15 that demonstrated children under 10 years had mild hyperopia and children aged 10–18 years had mild myopia, whereas adults had moderate to high myopia. Twelve patients with refractive error were prescribed spectacles.…”

Section: Discussionsupporting

confidence: 93%

“…The older age of onset observed in our study may explain why the Bielschowsky type was the most common etiology of AACE; this type is caused by prolonged uncorrected myopia and excessive near work in adults, which results in an imbalance of the convergence and divergence tone of the extraocular muscle and an increased force of the medial rectus muscles, leading to esotropia. 15–17 Moreover, our findings support the hypothesis that in Asian populations, AACE is more common in older children and adults than in younger children 15 for the same aforementioned reason.…”

Section: Discussionsupporting

confidence: 82%

See 1 more Smart Citation

Acute Acquired Comitant Esotropia: Etiology, Clinical Course, and Management

Lekskul¹,

Chotkajornkiat²,

Wuthisiri³

et al. 2021

OPTH

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Purpose To identify the etiologies, clinical course and management of acute acquired comitant esotropia in Ramathibodi Hospital, Thailand. Methods Thirty patients who were diagnosed with acute acquired comitant esotropia at Ramathibodi Hospital from January 1 2017 to December 31 2019 were identified using electronic medical records, from which demographic, etiology, clinical course and management, laboratory, and neuroimaging data were collected. Results The etiologies of acute acquired comitant esotropia were Swan (16.67%), Burian–Franceschetti (30.00%), Bielschowsky (36.67%), Arnold Chiari malformation (3.33%) and decompensated esophoria (13.33%). Mean age of onset was 19.8 ± 18.3 years. Mean angle of esodeviation was 28.4 ± 12.1 prism diopters for distance fixation and 29.3 ± 11.8 prism diopters for near fixation. Refraction differed between age groups: children under 10 years had mild hyperopia (median +0.63 diopters, first quartile +0.25 diopters, third quartile +0.75 diopters) and teenagers (10–18 years old) had emmetropia to mild myopia (median +0.25 diopters, first quartile −2.50 diopters, third quartile +0.75 diopters), whereas adults had mild to moderate myopia (median −0.75 diopters, first quartile −5.25 diopters, third quartile ±0.00 diopters). Twelve patients (40.00%) were prescribed spectacles and surgical intervention was performed in 26 patients (86.67%). All patients except one case of Arnold Chiari malformation (96.67%) maintained normal binocular function and alignment following strabismus surgery or spectacles correction. Conclusion Bielschowsky was the most common etiology of acute acquired comitant esotropia in our study. We suggest that refraction should be performed in all patients with acute acquired comitant esotropia. Most etiologies were benign and might not require neuroimaging. However, neuroimaging is recommended in those with atypical presentations, such as nystagmus, headache, or cerebellar signs. Surgical intervention with a 0.5–1.0 mm increase in recession was effective for restoring ocular alignment and binocular function in our patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 82%

Acute Acquired Comitant Esotropia: Etiology, Clinical Course, and Management

Lekskul¹,

Chotkajornkiat²,

Wuthisiri³

et al. 2021

OPTH

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“…Fu et al found that the mean deviation of esotropia in younger children was significantly larger than that in older children and adults in the Chinese population. A younger onset age may be a characteristic of AACE and may also be associated with esotropia deviation [11]. In our study, the younger patients experienced worse preinjection stereopsis and larger preinjection deviations for near and distance.…”

Section: Discussionsupporting

confidence: 46%

“…Some AACE cases were neuroimaging study-negative, systemic disease-negative, and without a history of neuro-or anesthesia-related medication use. Such AACE cases were associated only with refractive errors and binocular dysfunction, such as decompensated esophoria and high myopia, which were generally considered benign or functional [3,4,11,12]. AACE causes uncomfortable diplopia and substantially affects the quality of life.…”

Section: Introductionmentioning

confidence: 99%

Functional acute acquired comitant esotropia: clinical characteristics and efficacy of single Botulinum toxin type A injection

Tong

Tang

et al. 2020

BMC Ophthalmol

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Background To examine the clinical features of acute acquired comitant esotropia (AACE) and to evaluate the clinical effectiveness of a single injection of botulinum toxin type A (BTXA) on binocular visual function (BVF). Methods This retrospective, observational case series study enrolled patients with AACE examined from October 2018–May 2019. BTXA was injected into the both medial rectus muscles. The refractive error, best-corrected visual acuity (BCVA), stereoacuity, vergence, accommodation, the horizontal angle of deviation, and the gradient accommodative convergence/accommodation (AC/A) ratio were measured pre- and post-BTXA injection. Data pre- and postinjection were compared by the Wilcoxon signed-rank test. A Spearman correlation coefficient was calculated to explore the relationships between demographic characteristics and BVF. Results Twenty-two AACE cases were included. Compared with preinjection deviation, the postinjection deviation in the primary position was smaller for near (p < 0.001) and distance (p < 0.001) fixation at 3 months after injection (BTXA). Furthermore, convergence was better for near (p = 0.003) and distance (p < 0.001) fixation, divergence was better for near (p = 0.021) and distance (p < 0.001) fixation, accommodation was better in the right (p = 0.011) and left (p = 0.004) eyes, and the gradient AC/A ratio was better at the third month after injection (p = 0.001). Stereoacuity was improved in 11 (50%), unchanged in 5 (22.73%) and decreased in 6 (27.27%) patients. The preinjection stereoacuity (p = 0.013, r = 0.522) and preinjection deviation for near (p = 0.015 r, = − 0.512) and distance (p = 0.009, r = − 0.541) were significantly associated with patient age. Conclusions AACE is characterized by a high AC/A ratio and low accommodation. A single injection of BTXA is effective for AACE. Deviation, stereoacuity, and the therapeutic effect of BTXA may be correlated with patient age.

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“…In addition, the angle of deviation was larger in younger than in older children and adults. These findings are consistent with the results published by Fu et al, who described a large series of 69 Chinese patients with AACE, and with the series reported by Spierer, in which 9 of 10 adults with AACE were myopic [25,26].…”

Section: Discussionsupporting

confidence: 93%

Clinical Classification of Acquired Concomitant Esotropia

Gisselbaek

Hoeckele

Klainguti

et al. 2021

Klin Monbl Augenheilkd

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Background Classification and management of acquired concomitant esotropia is controversial. We sought to establish a simple clinical classification in order to determine in which cases further investigations in search of underlying pathologies are necessary. Patients and Methods Observational retrospective study of the files of 175 consecutive patients examined in our unit between 2009 and 2018 for acute convergent strabismus. One hundred and nine patients were selected, after exclusion of infantile, incomitant, or mechanical esotropias, residual esotropias, and patients examined on a single occasion. All patients received a complete orthoptic and ophthalmological examination. We grouped the patients according to their common characteristics. Results We established the following categories: 1. Acute esotropia of large angle (20 to 45 prism diopters [PD]), accompanied by mild hyperopia (mean 1.2 D) in children (n = 16) and moderate myopia (mean 3.7 D) in adolescents and adults (n = 13). 2. Decompensated micro-esotropia, which is distinguished from the other categories by the presence of abnormal retinal correspondence (n = 33). 3. Decompensated esophoria, with intermittent deviations of 5 to 30 PD, esotropia being compensated part of the time (n = 25). 4. Esotropia present only at a distance in patients over 50 years of age (n = 20). 5. Small-angle esotropia (< 15 PD) greater at a distance, associated with oculomotor cerebellar syndrome (n = 2). Complementary examinations (MRI or CT scan) were performed on 21 patients, leading to the discovery of a posterior fossa astrocytoma in a 4-year-old boy. Conclusions The recognition of decompensated micro-esotropia and esophoria, as well as distance esotropia of the elderly, avoids unnecessary additional investigations, which are indicated in any type of acute comitant strabismus if associated with any neurological sign or symptom (e.g., headaches, nausea, vertigo, imbalance, poor coordination, nystagmus, or papilledema). In the absence of neurological findings, there is no consensus about the indication of neuroimaging in large-angle acquired concomitant esotropia, but long-term follow-up of patients that do not undergo neuroimaging is strongly recommended in order to identify later occurring intracranial diseases. This is of particular importance with children.

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Clinical features of acute acquired comitant esotropia in the Chinese populations

Cited by 27 publications

References 21 publications

Acute Acquired Comitant Esotropia: Etiology, Clinical Course, and Management

Acute Acquired Comitant Esotropia: Etiology, Clinical Course, and Management

Functional acute acquired comitant esotropia: clinical characteristics and efficacy of single Botulinum toxin type A injection

Clinical Classification of Acquired Concomitant Esotropia

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