Epidemiology, clinical features, and surgical outcomes of acute acquired concomitant esotropia associated with myopia

Abstract

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.

The effects of refractive status on the outcomes of strabismus surgery in patients with esotropia

“…Vision acuity was evaluated using the Snellen chart, and these results were then translated into LogMAR format for easier comparison. Based on prior research indicating its influence on postoperative deviation outcomes, vision from the weaker eye was utilized for study purposes [ 18 ]. Criteria for identifying amblyopia included either a minimum vision of less than 20/30 in at least one eye or a vision disparity greater than two lines between the two eyes [ 19 ].…”

Advances in the diagnosis and treatment of acute acquired comitant esotropia

“…Excessive near-work activities may lead to increased tension in the medial rectus muscle, thereby disrupting motor fusion; overuse of digital devices at night significantly affects visual motion processing and ocular adjustment, resulting in the breakdown of motor and sensory fusion, thereby triggering the disease [ 2 ]. Roda et al, in their study of 117 AACE patients, hypothesized that long-term near-work activities may weaken the ability to relax fusion from near to distance vision, explaining why 94% of the patients experience diplopia at distant viewing points [ 12 ]. Studies have found that reducing near-work time helps decrease the degree of strabismus in AACE patients [ 13 , 16 , 17 ].…”

“…Research by Roda et al discovered a negative correlation between the deviation angle during diplopia episodes and age, hypothesizing a reduction in fusional reserves with aging. This could account for the occurrence of diplopia in the elderly with smaller esotropia angles [ 12 ]. A reduced fusional divergence amplitude may be one of the causes of AACE onset [ 18 ].The development of Type II AACE could be associated with a diminished fusional divergence amplitude [ 18 ].…”

“…Some scholars believe that for patients with a large angle of strabismus, unilateral MRrec + unilateral LRres is more effective than bilateral/unilateral MRrec, and shortening the lateral rectus muscle can effectively reduce the risk of postoperative recurrence and leave a fresh eye, which may be beneficial for possible future surgical needs [ 92 ]. Methods to evaluate surgical outcomes include assessing residual strabismus and its severity, recurrence of diplopia [ 12 ], restoration of stereopsis [ 93 ], and the balance in visual dominance [ 94 ]. The effectiveness of surgical treatment is influenced by various factors, which will be explained in the following sections.…”

Conformation of Horizontal Extraocular Muscle Insertions in Acute Acquired Concomitant Esotropia Induced by Excessive Digital Device Usage

“…3,4 Excessive accommodation is also one of the suggested etiologies. 5 Increases in AACE have been reported, 6 of which a large proportion were due to excessive usage of digital devices [7][8][9] including smartphones, tablets and computers. This special type of AACE, [10][11][12][13][14] which is called smartphoneassociated AACE (SAACE) herein, is thought to be induced by convergence spasm that follows excessive near work, with refraining from excessive near work suggested to be effective in helping to decrease the degree of esodeviation.…”