Surgical outcomes of acute acquired comitant esotropia of adulthood

Abstract

Background Acute acquired comitant esotropia (AACE) is a type of strabismus characterized by a sudden onset of large angle esotropia with diplopia, which often occurs in children after infancy, teenagers, and young adolescents. However, studies on the surgical outcomes of only adults are rare. The purpose of this article is to analyze the surgical outcomes for adult patients diagnosed with AACE. Methods Medical records of 24 patients who had undergone surgery for AACE were retrospectively analyzed. The main outcome measures were the final motor and sensory success rate after surgery and factors affecting motor and sensory outcomes. Motor success was considered alignment within 8 prism diopter (PD) at both near and distance and sensory success was stereoacuity ≥ 60 sec/arc. Results The preoperative mean esodeviation angles were 33.1 ± 10.4 PD at distance and 33.3 ± 11.2 PD at near. The mean period of postoperative follow up was 7.5 ± 4.5 months (range 1–8 months). The postoperative mean esodeviation angles at final follow-up time were 3.4 ± 6.1 PD at distance and 3.8 ± 6.7 PD at near. The surgical motor success rate at final follow-up was 79.2% (19/24). The sensory success rate at final follow-up was 50.0% (12/24). The factor affecting the motor outcome was the type of surgery (p < 0.05). The factor affecting sensory outcome was postoperative follow-up time (p < 0.05). Conclusions Surgery type appears to affect surgical motor outcomes in adults with AACE. Although the sensory outcome was favorable, it seems that regaining bifoveal fixation takes time.

The Effect of Different Treatment Methods on Acute Acquired Concomitant Esotropia

“…It is generally used for patients with a large degree of deviation or patients who have failed conservative treatment [ 18 ]. The timing of surgery is generally chosen when the deviation is relatively stable after more than 6 months of conservative treatment [ 19 ]. All 46 surgical patients in this study had an onset of more than 6 months, were ineffective in conservative treatment, and underwent surgery when their deviation was more stable.…”

Surgical Outcomes with and without Prism Adaptation of Cases with Acute Acquired Comitant Esotropia Related to Prolonged Digital Device Use

“…20 In that series, postoperative angles of deviation at distance and near were 0.8 ±1.6Δ and 0.7 ±1.8Δ, respectively, and 30 cases (68%) showed good stereoacuity (≤60)", similar to our results (p = 0.182). Kim and Noh also reported a favorable surgical motor success (alignment ≤8Δ) rate of 79% and a sensory success (stereoacuity ≤60") rate of 50% at the final follow-up in 24 cases of AACE, 21 in which 18 cases underwent UMR and lateral rectus resection, and six cases underwent BMR. In our study, the overall motor success rate was 81% and good stereoacuity Figure 1 Comparisons in near stereoacuity between group treated with surgery alone and group treated with surgery and prism adaptation.…”

“…The surgical dosage was calculated based on the formula of 3Δ/mm plus 0.5-1.0 mm in cases showing the smaller limbus-insertion distance of medial rectus muscle. [20][21][22] All surgeries were performed under general anesthesia in patients <15 years and local anesthesia for those ≥15 years old by two experimented surgeons (TY and YY). Each case was measured postoperative alignment at 1 day, at 1 week, and every 2 months after surgery.…”

Non-adjustable surgery for acute acquired comitant esotropia under general anesthesia

“…Surgical studies regarding AACE have revealed favorable surgical results [ 2 , 14 , 15 ]. In order to improve surgical results, variable methods such as increasing surgical dose, preoperative prism adaptation, consideration of surgical methods, and adjustable surgery could be considerate [ 4 , 15 , 16 ]. Williams and Hoyt reported that stereopsis could be achieved after surgical treatment of AACE without neurologic abnormalities [ 17 ].…”