When pediatric acute acquired comitant esotropia is not caused by a neurological disease

Dotan, Gad; Keshet, Yariv; Qureshi, Hanya M; Friling, Ronit; Yahalom, Claudia

doi:10.1016/j.jaapos.2019.09.016

Cited by 14 publications

(15 citation statements)

References 22 publications

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“…[4] However, the present study shows that the mean onset was 10 years and that none of the patients had an underlying intracranial disease. This is consistent with the results of studies by Erkan et al and Dotan et al, [19,21] who reported that patients presenting with isolated AACE with an onset at age >6 years did not have abnormal neuroimaging. A single clinical symptom or sign cannot reliably reveal whether AACE is secondary to a brain tumor.…”

Section: Acute Acquired Comitant Esotropiasupporting

confidence: 93%

“…[4,18] Recent studies have reported that AACE may occur in the absence of an associated neurological pathology in children and adults (Table 4). [3,10,[19][20][21][22] This is consistent with the present study, which reported a series of patients presenting with AACE who had no other ocular or neurological abnormalities and whose evaluation did not identify any intracranial pathology that would explain acute onset strabismus. None of the patients had medical ailments.…”

Section: Acute Acquired Comitant Esotropiasupporting

confidence: 92%

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Possibility of Neurological Diseases Associated with Acute Acquired Comitant Esotropia

Montriwet¹

2023

Korean J Ophthalmol

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This study investigated the possibility of neurological etiologies causing acute acquired comitant esotropia (AACE) and to evaluate the differences in clinical features between younger children, older children, and adults. Methods:In this retrospective analysis, patients who had been diagnosed with AACE between July 2017 and June 2021 were included. Data on clinical findings, medical history, brain or orbital imaging, and ophthalmological and orthoptic examinations were retrieved from medical records and analyzed.Patients were divided into three groups based on their age: younger children (<10 years), older children (10-18 years), and adults (>18 years).Results: Overall, 41 patients with AACE (15 females and 26 males) were examined. Most patients were children. Mild hyperopia was observed in children, while adults had moderate to high myopia. The mean angle of esotropia at a distance fixation was 43.57±9.77, 51.54±8.75, and 30.14±12.39 prism diopters (PD) in younger children, older children, and adult groups, respectively. The mean angle of esotropia at a near fixation was 43.57±9.37, 51.15±9.39, and 31.43±12.15 PD in younger children, older children, and adult groups, respectively. Significant differences were found in the mean angles of esotropia in patients with AACE at both near and far distances according to their age (P<0.001, P<0.001, respectively). Among 36 patients with previous neuroimaging data, none had AACE secondary to intracranial lesions. Over two years, five patients who were under continuous observation did not develop any neurological abnormalities. Conclusion:AACE was more common in children than in adults. The angle of deviation was larger in children than in adults. Coexisting or underlying neurological diseases were not present in patients with Acute Acquired Comitant Esotropia isolated AACE, which eliminated the need for neuroimaging. Continuous follow-up evaluations are warranted when signs of intracranial disease are observed in patients who have not undergone an imaging investigation.

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Section: Acute Acquired Comitant Esotropiasupporting

confidence: 93%

Section: Acute Acquired Comitant Esotropiasupporting

confidence: 92%

Possibility of Neurological Diseases Associated with Acute Acquired Comitant Esotropia

Montriwet¹

2023

Korean J Ophthalmol

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“…One other missing factor in most studies is, that the authors do not differentiate between different types of acquired non-accommodative esotropia [6][7][8]. Therefore, the aim of this study was to evaluate the effect of PAT on the AOS in decompensated esophoria (decEPH) and decompensated microesotropia (decMET).…”

Section: Introductionmentioning

confidence: 99%

Prism adaptation test before strabismus surgery in patients with decompensated esophoria and decompensated microesotropia

2022

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Purpose To evaluate the effect of Prism adaptation test (PAT) on the angle of squint in decompensated esophoria (decEPH) and decompensated microesotropia (decMET). Methods In this single-center retrospective study we reviewed the medical records of patients with the diagnosis of decEPH or decMET, aged at least 12 years, who were treated by strabismus surgery for the first time. The maximum Angle of squint (AOS) for far (F) and near (N) fixation and PAT results before surgery, as well as AOS (F) and AOS (N) after surgery and results of binocular function tests were considered. PAT included wearing a prism based on the largest angle for over 60 min. Results 100 patients (mean age 37 ± 17 years) were included in the decEPH group, 82 patients (mean age 30 ± 13 years) in the decMET group. For decEPH, before surgery AOS was 25.5 ± 8.8 pdpt (F) and 23.5 ± 9.8 pdpt (N). During PAT the AOS increased significantly by 2.7 ± 4.3 to 28.2 ± 8.6 pdpt (F) and by 4.9 ± 4.5 to 28.3 ± 9.5 pdpt (N). Altogether, in 82% of decEPH patients AOS (F) and/ or AOS (N) in- or decreased by at least 3 pdpt. For decMET, before surgery AOS was 28.6 ± 10.8 pdpt for far (F) and 30.9 ± 11.8 pdpt for near fixation (N). During PAT the AOS increased significantly by 4.2 ± 5.8 to 32.5 ± 9.5 pdpt (F) and by 3.7 ± 6.1 to 34.4 ± 9.5 pdpt (N). Altogether, in 51% of decMET patients, AOS (F) and/ or AOS (N) increased by at least 10 pdpt, therefore more than 5° which would have been maximally expected from mictrotropia, or decreased by at least 3 pdpt. Conclusions The Prism adaptation test (PAT) showed remarkable changes in AOS in both decEPH and decMET. In patients with decEPH, the preoperative assessment of the “true AOS” under PAT reflects a pivotal requirement for successful strabismus surgery, as 82% had dose relevant angle changes ≥ 3 pdpt. For patients with decMET the preoperative prism adaptation test is especially of diagnostic value, but also 51% of decMET patients had changes in AOS beyond the expected microtropic angle (≥ 10 pdpt) or even a dose relevant angle decrease (≥ 3pdpt).

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“…Es liegen jedoch zahlreiche Fallbeispiele mit zugrunde liegender neurologischer Grunderkrankung wie intrakraniellen Tumoren, Hydrozephalus oder Arnold-Chiari-Malformation vor [4]. Die Konkomitanz des Schielwinkels und das Fehlen auffälliger neurologischer Begleitsymptome schließen eine ernste neurologische Erkrankung jedoch nicht aus [4,5]. Das AACE kann das erste oder einzige Zeichen einer intrakraniellen Erkrankung sein [4,6].…”

Section: Introductionunclassified

“…Die Konkomitanz des Schielwinkels und das Fehlen auffälliger neurologischer Begleitsymptome schließen eine ernste neurologische Erkrankung jedoch nicht aus [4,5]. Das AACE kann das erste oder einzige Zeichen einer intrakraniellen Erkrankung sein [4,6]. Buch und Vinding geben 4 Risikofaktoren für eine neurologische Assoziation bei Kindern an: Schielbeginn > 6 Jahre, sehr großer Schielwinkel, Fernwinkel > Nahwinkel, neurologische Befunde (Papillenödem, Ataxie, Kopfschmerzen) und rezidivierender Strabismus [7].…”

Section: Introductionunclassified

Akut erworbene konkomitante Esotropie Typ 2 – eine retrospektive Analyse

Geiger

Simonsz-Tòth

Gerth‐Kahlert

2021

Klin Monbl Augenheilkd

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Zusammenfassung Hintergrund Akutes erworbenes konkomitantes Einwärtsschielen (acute acquired comitant esotropia, AACE) ist eine seltene Schielform. Es besteht Konsens, dass zu den klinischen Merkmalen des AACE Typ 2 im Kindesalter folgende Merkmale gehören: akuter Schielbeginn im etwa 3. Lebensjahr, relativ großer konkomitanter, nicht akkommodativer Schielwinkel, Hyperopie von maximal 3,0 dpt und eine normale Sensorik. Die Diagnose eines AACE Typ 2 stellt eine dringliche Therapieindikation dar, um einen irreversiblen Verlust des bereits erworbenen binokularen Sehens zu vermeiden. Um die klinischen Charakteristika von AACE Typ 2 zu analysieren, wählten wir folgendes Studiendesign. Patienten und Methoden Retrospektive Datenanalyse der Patienten, die zwischen Oktober 2011 und September 2019 eine Strabismusoperation aufgrund der Verdachtsdiagnose eines AACE Typ 2 an unserer Klinik erhielten, welche sich auch postoperativ anhand von Stellung und Binokularitätsgrad bestätigen ließ. Analysierte Daten beinhalteten: Alter und Symptome bei Erstuntersuchung, Visus, Refraktion, Brillenkorrektur, Alter bei Operation, Intervall von Erstsymptomatik bis zur Operation, Operationsverfahren, Schielwinkel und Binokularitätsgrad (präoperativ und postoperativ 1 Tag, postoperativ 3 und 12 Monate). Die Analyse wurde durch die kantonale Ethikkommission Zürich genehmigt. Ergebnisse Daten von 18 Patienten (12 männlich, 6 weiblich) konnten in die Studie eingeschlossen werden mit einer Hyperopie von 1,4 ± 0,6 dpt. Eine Amblyopie lag in 2 Fällen vor. Das Alter bei Operation lag zwischen 2,0 und 11,1 Jahren mit einem Intervall zwischen Erstsymptomatik und der Operation von 0,4 bis 24,6 Monaten. Eine Operation wurde innerhalb von 6 Monaten nach Schielbeginn bei 12/18 Kindern durchgeführt. Der präoperativ gemessene Schielwinkel lag in der Nähe bei 38 ± 10 Prismendioptrien (PD) und reduzierte sich nach 3 und 12 Monaten auf 3 ± 3 PD resp. 2 ± 2 PD. Stereosehen erreichten am 1. operativen Tag 5/18 Kinder, nach 12 Monaten dann 18/18 Kinder. Schlussfolgerung Die Evaluation unserer Patientengruppe mit postoperativ gesicherter Diagnose AACE Typ 2 zeigt, dass in allen Fällen eine geringe Hyperopie, eine große konkomitante, nicht akkommodative Esotropie bestand und die Prognose zur Wiederherstellung von normaler Stereopsis ausgezeichnet ist. Das Vorliegen einer präoperativen Amblyopie schließt eine Normosensorik nach erfolgter Strabismuskorrektur nicht aus. Eine zeitnahe therapeutische Intervention sollte bei Vorliegen o. g. Charakteristika angestrebt werden.

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When pediatric acute acquired comitant esotropia is not caused by a neurological disease

Cited by 14 publications

References 22 publications

Possibility of Neurological Diseases Associated with Acute Acquired Comitant Esotropia

Possibility of Neurological Diseases Associated with Acute Acquired Comitant Esotropia

Prism adaptation test before strabismus surgery in patients with decompensated esophoria and decompensated microesotropia

Akut erworbene konkomitante Esotropie Typ 2 – eine retrospektive Analyse

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