Esotropic Patients Research Articles

Multiple factors causing variability of alignment in childhood concomitant strabismus

Purpose: To investigate the potential factors related to variability of alignment in childhood concomitant strabismus. Design: Prospective inter-examiner (test-retest) reliability analysis. Methods: In total, 197 children with concomitant strabismus (57 esotropia, 140 exotropia) underwent repeat prism and alternate cover test (PACT) by two orthoptists who were certified by the study, and sensory tests were all performed once. We defined the alignment measurement as stable if the absolute value of the measurement difference between two orthoptists was within 10 prism diopters (PD), and unstable if the difference was 10 PD or greater. We analyzed the relationship between the measurement variability and sensory results, patient age, and angle of deviations. Results: The mean age of the esotropia and exotropia patients was 68.5 ± 26.3 months (range, 36–164 months) and 96.0 ± 33.7 months (range, 22–200 months), respectively, and there was a significant difference in suppression related variability of alignment, both at distance (P = 0.004) and at near (P = 0.046). Anisometropia also showed a significant difference at distance (P = 0.035) for variability of alignment, and there was no significant statistical effect of age on measurement variability in our study. Variability of alignment is positively associated with the angle of deviation, especially at distance (P = 0.021 for exotropia, P = 0.002 for esotropia) with more variability between observers with larger angles of misalignment. Conclusion: Suppression is an important factor for variability of alignment in childhood concomitant strabismus. Other factors, such as anisometropia and a large angle of strabismus should be taken into account when evaluating binocular alignment.

Factors influencing the therapeutic effect of hyperopic correction on esotropia in patients with partially accommodative esotropia.

To collate data on partially accommodative esotropia (PAET) to better understand this condition's aetiology and to evaluate and predict the therapeutic effect of a hyperopic correction on PAET. Eighty-nine consecutive patients diagnosed with PAET with a spherical equivalent (SE) refractive error >+2.50 D were included in this retrospective review. Clinical characteristics, including gender, age, SE, angle of esodeviation, accommodative convergence/accommodation (AC/A) ratio, near-distance disparity (NDD) and anatomical features of the rectus muscles were compared among different PAET subgroups. Multiple linear regression was used to identify independent factors that influenced the therapeutic effect of a hyperopic correction on esotropia. No significant differences were observed for the angle of esodeviation as a function of age in individuals with PAET. The incidence of SE in PAET participants >9 years old was significantly greater than in those <5 and 6-8 years of age. The therapeutic effect of hyperopic correction on esotropia was positively associated with SE both at distance and near. In addition, the limbus insertion distance (LID) of the lateral rectus (LR) muscle was positively associated with NDD at distance, but negatively associated at near. A greater incidence of hyperopia was observed in older (>9 years old) PAET patients. A hyperopic correction had a greater effect on esotropia in individuals with a higher SE, larger LID of the LR muscle and a smaller NDD.

Medial Rectus Disinsertion for the Management of Large-Angle Sensory Esotropia.

Background and Objectives: The aim of the report is to report the outcomes of the medial rectus (MR) disinsertion procedure for the management of large-angle esotropia (ET) patients. Materials and Methods: This is a retrospective case series of patients with large-angle ET who underwent an MR disinsertion procedure between March 2012 to April 2022. The procedure happened accidentally during muscle surgery. The demographic and clinical data, including sex, age, visual acuity, pre- and postoperative angle of strabismus, duction limitations, results of intraoperative forced duction tests, and follow-up duration were collected from medical records. Results: Five patients were enrolled in this study. The mean age was 62.2 ± 9.8 years, and the mean follow-up was 24.8 ± 8.7 months. The ET at the primary position of gaze was 92.0 ± 17.9 prism diopters (PD) before MR disinsertion and 38.0 ± 29.5 PD after MR disinsertion only. Abduction deficiency was -4 before after MR disinsertion, which improved to -1 at the last follow-up. Conclusions: The results of MR disinsertion were not as frustrating as anticipated. MR disinsertion may be considered in patients with large-angle sensory ET who refuse surgery on the opposite eye.

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

BackgroundThe success of the strabismus surgery can hinge on several factors. One of these factors is refractive condition like hyperopia or myopia. Our study seeks to evaluate the surgical outcomes in patients with esotropia and myopia.MethodsThis case-control study encompassed all surgical cases of esotropia at Torfe and Negah Hospital between 2016 and 2021, which satisfied our specified inclusion criteria. The initial variables from electronic medical records were collected, including demographic, clinical, and surgery-related factors. At the final follow-up appointment, the level of eye deviation, both at distance and near, was recorded. We considered the operation a “success” for patients with a post-surgery distance eye deviation of 10(Pd) or less. Patients with greater deviation were classified as surgery failure. Statistical analyses were executed using SPSS software (version 16.0), and a P-value less than 0.05 was considered significant.ResultsOf the 194 patients evaluated, 112 were incorporated into the study. Surgical failure was observed in 14.29% of myopic patients, 29.79% of hyperopic patients, and 31.82% of emmetropic patients. The myopia group displayed a 0.19 odd ratio for surgical failure compared to the combined hyperopia and emmetropia groups, not statistically significant (OR: 0.19, CI 95%: 0.03–1.02). Additionally, patients diagnosed with Lateral Rectus Under-action were found to be 6.85 times more likely to experience surgery failure(OR: 6.85, CI 95%: 1.52–30.94). An elevated risk of surgical failure was also identified in patients who underwent Inferior Oblique Weakening procedure, indicated by a 3.77-fold increase in the odds ratio for failure(OR: 3.77, CI 95%: 1.08–13.17).ConclusionIn our study, despite numerical disparities, there was no statistical difference among the success rates of all esotropia patients with different refractive errors. The patients with LRUA or IOOA showed lower success rates. Myopic patients had higher post-op overcorrection with lower reoperation rates compared to hyperopic or emmetropic patients.

Effect of 4-week preoperative prism adaptation in preventing postoperative residual esotropia.

Preoperative prism adaptation (PPA) simulates postoperative status and possibly can predict postoperative undercorrection before surgery in esotropia. The present study aimed to assess the effect of 4-week PPA in preventing postoperative residual esotropia. Seventy-five (75) esotropes who had undergone surgery at a single strabismus center were retrospectively enrolled. They included 25 basic, 31 acute comitant, 10 partially accommodative, and 9 recurrent esotropia patients. The preoperative deviation angle, which had been determined using the alternating prism and cover test, was fully corrected with press-on prisms 4 weeks before surgery. If there was an increase of 5 PD or more of esodeviation, the prisms were changed accordingly at 2 weeks. The deviation angle measured at 4 weeks was determined as the surgical target angle. Patients were then divided into increase (≥ 5 PD increase of angle during 4-week PPA) and non-increase groups. Success was defined as either esodeviation of 8 PD or under or exodeviation of 5 PD or under at distance at postoperative 6 months. The increase group included 44 patients (58.7%). The mean deviation angle before PPA was 27.4 PD, and after the 4-week PPA, there was an average increase of 9.4 PD. The success rate was 90.9% in the increase group and 96.8% in the non-increase group (p = 0.316). There were no intergroup differences in preoperative clinical characteristics, esotropia types, postoperative deviation angle or postoperative near stereopsis (p > 0.05). The results of this study indicated a beneficial effect of 4-week PPA in esotropia of various types, specifically by uncovering the hidden esodeviation in the increase group and simulating the postoperative alignment in both the increase and the non-increase groups.

Effects of cycloplegia on crystalline lens morphology and location in acute acquired concomitant esotropia.

The study aims to compare morphology and location of crystalline lens between acute acquired concomitant esotropia (AACE) patients and control subjects, both before and after cycloplegia. This is a prospective and observational clinical study. Morphological and locational parameters of the crystalline lens in 53 AACE patients and 32 control subjects were assessed before and after cycloplegia using CASIA2 system, which represents the latest swept-source anterior segment optical coherence tomography. Cycloplegic refraction was recorded by administering 1% atropine in patients younger than 12years and 1% cyclopentolate in those > 12years old. Morphological parameters included anterior radius of curvature (ARC), posterior radius of curvature (PRC), lens thickness (LTH), and equivalent diameter of lens (LED). Locational parameters comprised lens decentration (LD) and lens tilt (LT). Comparison of these parameters before and after cycloplegia were conducted between AACE and controls. Additionally, the study analyzed and compared the changes in these parameter post-cycloplegia. Our findings suggest no significant difference in morphological parameters including ARC, PRC, LTH and LED between AACE patients and controls before or after cycloplegia. However, 2D-modeling data in the 0° meridian revealed that variation post-cycloplegia of LD (lens shift) in right eyes was different in AACE patients, measuring - 0.03(0.08) [median(interquartile range)] which was significantly distinct from the control group, exhibiting a measurement of 0.01(0.06) (z = - 2.373, p = 0.018). In left eyes, a similar trend was observed with lens shift in the 0° meridian being 0.02(0.06) in AACE, significantly differing from control group's measurement of - 0.02(0.08) (z = - 2.809, p = 0.005). Further, correlation analysis revealed that larger temporal shift of lens was associated with greater changes in ARC (r = 0.294, p = 0.006) and LTH (r = - 0.230, p = 0.031). The morphological features of the crystalline lens were similar in AACE patients and controls; however, the change of lens location by cycloplegia was observed only in AACE patients, suggesting an association with excessive accommodation.

SURGICAL MANAGEMENT IN ESOTROPIA AT CIPTO MANGUNKUSUMO HOSPITAL: A 4-YEAR OBSERVATION ON CHARACTERISTIC AND RESULT

Introduction: Esotropia, although have low prevalence in Indonesia, give significant impacts on its sufferer, and due to the wide range of types creates numerous options for surgery without much consensus. Success rates of the surgery also varied depends on many factors. This study aims to evaluate clinical characteristics, success rate in esotropia surgery, and factors that may influence the outcome. Methods: A retrospective descriptive study based on secondary data from medical records of child and adult esotropia patients who underwent surgery from January 2018 to December 2021. Result: Of 68 patients included in the study, 60.2% were adults. More than half of patients have an onset before 7 years of age, though amblyopia only affects 29.4% of patients. Squinted-eye was the chief complaint in most patients (76.5%). One-third of patients had basic type esotropia and 59.7% had large preoperative deviation. Unilateral procedure was done in 50% of patients. The surgery success rate reached 65% with good stability on 8 months of follow-up. Better results were seen in congenital and basic type esotropia than in other types. Although none of the believed influenced factors affecting outcome were significant statistically, duration &lt;5 years and preoperative deviation &lt;50 PD had a higher success rate of 75% and 84.6%. Conclusion: Esotropia surgery in Cipto Mangunkusumo hospital were performed majorly in adults with large pre-operative deviations, mostly by unilateral procedure of recession and resection. The surgeries yield good results and stability, with shorter duration and smaller preoperative deviation giving higher success rates.

Clinical profile of esotropia patients in a tertiary care center with application of the CEMAS classification

Abstract Aims: This studyaims to study the clinical profile of patients with esotropia (ET) in a tertiary care centre. Materials and Methods: A cross-sectional observational study was carried out on 94 patients with ET seen in the ophthalmology outpatient department of a tertiary care center from December 2018 to June 2020. Results: A female preponderance was noted with male:female ratio of 0.8:1. Although 79 patients (84.04%) had noticed the onset of ET in the first decade of life, only 50 (53.19%) of the patients presented to the ophthalmologist in the first decade of life. Family history of ET was present in only 7.44% of patients. Amblyopia was present in 31 (32.97%) patients. The most common refractive error seen was hypermetropia followed by hypermetropic astigmatism. Based on the Classification for Eye Movement Abnormalities and Strabismus (CEMAS), there were 36 (40.42%) patients with refractive accommodative ET, 15 (15.95%) of infantile ET, 13 (13.82%) patients had ET due to visual/neurological disease, 16 (15.95%) patients had cranial neuropathy and there was one child with neuromuscular cause – Duane’s retraction syndrome (Type 1). Conclusion: Most of the patients in the study sought consultation for the management of ET late in life though it was noticed in early childhood. Majority of the patients had refractive accommodative ET. These can be managed appropriately if diagnosed early. A significant number of patients had amblyopia as sequelae of untreated ET. Early diagnosis and appropriate management at the right time are very important in patients with ET to prevent the development of amblyopia and maintain binocularity.

Clinical characteristics of acute acquired concomitant esotropia before and after the COVID-19 pandemic: a retrospective analysis.

This study aimed to observe the clinical characteristics of acute acquired concomitant esotropia (AACE) patients in recent five years and to examine the changes in the proportion of AACE cases before and after the COVID-19 pandemic. A retrospective study included 148 patients who underwent strabismus correction surgery for AACE between January 1, 2017, and December 31, 2021. The study analyzed the changing proportion of AACE cases before and after the COVID-19 pandemic and analyzed its clinical characteristics. Abnormalities in the worth 4 dot examination (both distance and near) were present in 134 cases (90.54%) before surgery, while 140 cases (94.59%) showed normal results after surgery. Near stereoacuity was present in 135 cases (91.22%). The near and distance deviations were (55.01 ± 18.77) PD and (57.30 ± 17.64) PD, respectively, and there was no significant difference between the two (p = 0.279). There were significant differences in the ratio of refractive status among different age groups (p < 0.001), while no statistically significant difference was observed in the ratio of refractive status for near deviation (p = 0.085) or distance deviation (p = 0.116). The proportion of AACE cases after the COVID-19 pandemic was significantly higher than that before the COVID-19 pandemic (p = 0.042). There was no statistically significant difference in the clinical characteristics between the two groups (p > 0.05). Myopia is the most common refractive status in AACE. More than half of patients had occupations that involved long hours of close work. The proportion of AACE cases increased significantly after the COVID-19 pandemic.

Presence of Copy Number Variants Associated With Esotropia in Patients With Exotropia

Strabismus is a common ocular disorder of childhood. There is a clear genetic component to strabismus, but it is not known if esotropia and exotropia share genetic risk factors. To determine whether genetic duplications associated with esotropia are also associated with exotropia. This was a cross-sectional study conducted from November 2005 to December 2023. Individuals with constant or intermittent exotropia of any magnitude or a history of surgery for exotropia were recruited from pediatric ophthalmic practices. Data were analyzed from March to December 2023. Genetic duplication. Presence of genetic duplications at 2p11.2, 4p15.2, and 10q11.22 assessed by digital droplet polymerase chain reaction. Orthoptic measurements and history of strabismus surgery were performed. A total of 234 individuals (mean [SD] age, 19.5 [19.0] years; 127 female [54.3%]) were included in this study. The chromosome 2 duplication was present in 1.7% of patients with exotropia (4 of 234; P = .40), a similar proportion to the 1.4% of patients with esotropia (23 of 1614) in whom it was previously reported and higher than the 0.1% of controls (4 of 3922) previously reported (difference, 1.6%; 95% CI, 0%-3.3%; P < .001). The chromosome 4 duplication was present in 3.0% of patients with exotropia (7 of 234; P = .10), a similar proportion to the 1.7% of patients with esotropia (27 of 1614) and higher than the 0.2% of controls (6 of 3922) in whom it was previously reported (difference, 2.8%; 95% CI, 0.6%-5.0%; P < .001). The chromosome 10 duplication was present in 6.0% of patients with exotropia (14 of 234; P = .08), a similar proportion to the 4% of patients with esotropia (64 of 1614) and higher than the 0.4% of controls (18 of 3922) in whom it was previously reported (difference, 5.6%; 95% CI, 2.5%-8.6%; P < .001). Individuals with a duplication had higher mean (SD) magnitude of deviation (31 [13] vs 22 [14] prism diopters [PD]; difference, 9 PD; 95% CI, 1-16 PD; P = .03), were more likely to have constant (vs intermittent) exotropia (70% vs 29%; difference, 41%; 95% CI, 20.8%-61.2%; P < .001), and had a higher rate of exotropia surgery than those without a duplication (58% vs 34%; difference, 24%; 95% CI, 3%-44%; P = .02). In this cross-sectional study, results suggest that the genetic duplications on chromosomes 2, 4, and 10 were risk factors for exotropia as well as esotropia. These findings support the possibility that esotropia and exotropia have shared genetic risk factors. Whether esotropia or exotropia develops in the presence of these duplications may be influenced by other shared or independent genetic variants or by environmental factors.

The outcome of horizontal strabismus surgery in Anbar governorate in Iraq: an interventional study

Background: Strabismus is the loss of ocular alignment, which can lead to amblyopia, defective binocularity, and defective depth perception. Objectives: To assess the results of strabismus surgery among patients older and younger than six years and study the influencing and predictive factors. Methods: Surgical treatment for 202 patients clinically diagnosed with horizontal strabismus aged 4-45 years was carried out in Fallujah Teaching Hospital between September 2021 and October 2022. Surgical outcome was assessed at the end of 6 months post-operatively. Chi-square and Mann-Whitney Univariate tests were performed to evaluate the statistical relationship between pre-operative factors and surgical outcomes. Results: Overall, the success rate of horizontal strabismus surgery was 68.3% (138 patients), and the rate of success among the esotropia group (55.1%) was better than the exotropia group (44.9%). Among age groups, a higher recorded success rate was for ages above 6 (71.7%). The success rate was higher in males than females (54.3% and 45.7%, respectively). Chi-square and univariate analysis showed a significant association between gender (p &lt; 0.068), refractive error (p &lt; 0.033), and surgical outcome. Conclusion: Surgical correction of strabismus improved overall ocular deviation and binocular function. Esotropia patients benefited the most compared to exotropia patients.

Decrease of over-elevation in adduction after surgery of medial rectus muscles in partially refractive accommodative esotropia.

The course of over-elevation in adduction after strabismus surgery has been evaluated in a small number of research in the literature, we believe our study is the first to report the results in a specific group of esotropia (ET) patients. To report the course of postoperative over-elevation in adduction in patients who underwent surgery for horizontal deviation on the medial recti in partially accommodative ET. The medical charts of patients who had partially accommodative ET with over-elevation in adduction were reviewed retrospectively. A scale from -4 to +4 was used to grade the oblique muscle function. Among these, 17 patients who were operated solely on the horizontal rectus muscles were identified. The primary outcome measure was the degree of improvement in over-elevation in adduction after medial rectus surgery. Nine (52.9%) of the 17 patients (mean age: 5.18 ± 2.24 months) were males and 8 (47.1%) were females. The mean follow-up period was 17.06 ± 15.32 months. Overall, 15 patients (88.2%) achieved surgical success. The mean inferior oblique overaction was found 1.44 ± 0.56 preoperatively and the final postoperative mean inferior oblique overaction was 0.53 ± 0.51 (P = 0.001). Postoperative over-elevation in adduction after 3 months was significantly decreased compared to the preoperative value (P = 0.003, P = 0.001, P = 0.001 at 3rd and 6th months and final visits respectively). Over-elevation in adduction accompanying partially refractive accommodative ET seems to regress after medial rectus weakening surgery. This finding should be considered in the presurgical evaluation of these patients.

Comparative Analysis of Strabismus Measurement Using a Video Oculagraphy System and Alternate Prism Cover Test.

The aim of the study was to compare distance vision measurements obtained with video oculography (VOG) and an alternate prism cover test (APCT). Single-center, retrospective, and cross-sectional. Eighty-seven subjects with strabismus were included. All patients underwent an optometric examination. The measurement of strabismus in distance vision was performed with the best optical correction using the APCT and the VOG GazeLab. Subjects were divided according to the type of strabismus; 41 were esotropic and 46 were exotropic. The general comparison of APCT and VOG showed a mean difference of 0.60±2.74 prism diopters (Δ), not observing statistical differences between both methods ( P =0.059) and presenting a correlation of 0.976 ( P <0.001). Using APCT, the mean amount of esotropia for the group was 18.31±11.64 Δ and that of exotropia was 19.62±8.80 Δ. Compared with the VOG, the mean value of esotropia for the group was 18.65±11.65 Δ and that of exotropia was 19.48±8.62 Δ. The means are statistically different for the esotropia group ( P =0.005) but not for the exotropia group ( P =0.318). There was a high direct correlation between the methods of measurement for both the esotropic ( R =0.980; P <0.001) and exotropic patients ( R =0.975; P <0.001). Bland-Altman analysis shows a mean difference of 1.37±2.76 Δ for the esotropia patients and 0.31±2.66 Δ for the exotropic patients, respectively. This study demonstrated comparable results in measuring strabismus between VOG and APTC for esotropia and exotropia, with an excellent correlation between both methods and good agreement, especially in subjects with exotropia.

Deficits of Visual Cortex Function in Acute Acquired Concomitant Esotropia Patients.

The purpose of this study was to explore the cortical deficits of patients with acquired concomitant esotropia (AACE) using the resting-state functional magnetic resonance imaging (rs-fMRI) technique. Rs-fMRI signals from 25 patients with AACE and 25 matched controls were collected. The repeated-measures analysis of variance (RM-ANOVA) test and two-sample t-test were used to investigate statistical differences of the amplitudes of low-frequency fluctuation (ALFF) signals and correlation analysis was performed to validate the relationship of signal change and clinical features. The AACE group showed decreased ALFF in both hemispheres symmetrically (t = 0.38, P = 0.71), with peak t in both middle occipital gyrus. The ALFF signal from the upper left inferior frontal gyrus was negatively correlated with the age of onset (r = 0.62, P = 0.0008), and the ALFF signal from the right superior temporal gyrus was negatively correlated with the near work hours (r = 0.63, P = 0.0008). The ALFF signal in the left fusiform gyrus was positively correlated with both near (r = 0.48, P = 0.01) and far (r = 0.44, P = 0.03) deviation, whereas it was only positively correlated with far deviation (r = 0.44, P = 0.03) in the right. Besides, the age of onset and the near work hour were independent factors of signal changes. Using the ALFF signal of rs-fMRI, we found functional deficits in the primary visual cortex and dorsal pathway in patients with AACE. There were functional changes in the fusiform gyrus, and the greater the deviation angle, the higher the changing level. These findings reveal the association of AACE and the visual center, giving us more clues about the treatment of AACE.

Basic acquired nonaccommodative esotropia patients managed with surgery; a study of 2102 patients

ABSTRACT Introduction Several studies investigated preoperative clinical features of patients with basic-acquired nonaccommodative esotropia (BANAET); however, their sample sizes were small, and they did not compare the clinical features among cases that needed different surgery times. The main purpose of this study is to compare the preoperative clinical features of patients with BANAET managed with one surgery with patients who underwent two or more strabismus surgery over 10 years. Methods This historical cohort study was performed on the hospital records of 13,252 Iranian strabismic patients who underwent surgery at Farabi eye hospital, Tehran, Iran, from 2012 to September 2022. Of those, 2102 cases with BANAET were selected as the sample size. Data collected included sex, age at the time of first surgery, corrected distance visual acuity (CDVA), refractive error, presence of amblyopia, angle of deviation, and times of surgery. Results The mean age was 18.9 ± 15.6 [1200 (57.1%) males and 902 (42.9%) females] and the median age was 14 years. In 1599 (76.1%) patients, esotropia was managed with one surgery; however, 342 (16.3%) cases were managed with two surgeries and 161 (7.6%) patients underwent three or more surgeries. The mean angle of horizontal deviation at distance and near in patients managed with two and ≥3 surgeries was significantly higher than in cases managed with one surgery (P < .001). Amblyopia was observed in 289 (18.1%) patients who were managed with one surgery, 69 (20.2%) patients with two surgeries and 43 (26.7%) patients with three or more surgeries (P < .001). Patients with BANAET managed successfully with only one surgery were younger, had better CDVA, lower astigmatism and less horizontal angle of deviation at distance and near than those who underwent two or more surgeries (all P < .001). Discussion The higher astigmatism, lower CDVA, greater angle of horizontal deviation, and higher frequency of amblyopia were found in the preoperative examinations of BANAET patients managed with two or more surgeries compared with cases managed with only one surgery.

Diffusion tensor imaging of horizontal extraocular muscles in patients with concomitant and paralytic esotropia.

To assess metrics of diffusion tensor imagining (DTI) in evaluating microstructural abnormalities of horizontal extraocular muscles (EOM) in esotropia. Six adult concomitant esotropia patients, 5 unilateral abducent paralysis patients and 2 healthy volunteers were enrolled. Conventional magnetic resonance imaging (MRI) and DTI were performed on all subjects using 3T MR scanner. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) of medial and lateral rectus muscles were measured and compared between patients group and control group. Medial rectus MD and RD within the adducted eye of concomitant patients was significantly greater than that in unilateral abducent paralysis patients (0.259×10-2 mm2/s vs 0.207×10-2 mm2/s, P=0.014; 0.182×10-2 mm2/s vs 0.152×10-2 mm2/s, P=0.017). Both strabismus patients showed a significantly decreased MD and AD than that obtained in normal controls for lateral rectus muscles (P<0.05). Medial rectus MD of the adducted eye in concomitant strabismus patients was significantly decreased than that in healthy controls (0.259×10-2 mm2/s vs 0.266×10-2 mm2/s, P=0.010). Lateral rectus AD of the adducted eye in concomitant strabismus patients was significantly decreased as compared with that in healthy controls (0.515×10-2 mm2/s vs 0.593×10-2 mm2/s, P=0.013). No statistically significant differences were present between the adducted and fixating eyes in concomitant strabismus patients. DTI represents a feasible technique to assess tissue characteristics of EOM. The effects of eye position changes on DTI parameters are subtle. Decreased MD and RD could be evidence for remodeling of the medial rectus muscle contracture. Lower medial and lateral recuts MD of concomitant esotropia patients indicates a thinner fibrous structure of the EOM. Lower MD and AD should be general character of esotropia.

Strabismus in Retinopathy of Prematurity: Risk Factors and the Effect of Macular Ectopia.

This study aimed to examine factors associated with strabismus in patients with retinopathy of prematurity (ROP) and the relationship between strabismus and macular ectopia. Patients with ROP were divided into three groups: Group 1, patients with spontaneous regression (n=45); Group 2, patients who received laser treatment (n=70); and Group 3, patients who underwent surgical treatment (n=91). Rates of anisometropia, amblyopia, nystagmus, macular ectopia, and retinal pathologies were evaluated and their impacts on strabismus development were determined. Disc-to-fovea distance (DFD) was measured from color fundus photographs and the correlation of macular ectopia with severity of strabismus was evaluated. A total of 206 patients were included. Rates of anisometropia, amblyopia, nystagmus, macular ectopia, retinal pathologies causing vision loss, and strabismus were higher in Group 3 (p=0.0001) and correlated with higher stages of ROP (p=0.0001). Macular ectopia (p=0.005), retinal pathologies (p=0.005), and amblyopia (p=0.012) had the strongest impact on strabismus development in ROP patients. DFD and strabismus severity were not significantly correlated (p=0.364). Mean visual acuity (VA) was significantly higher in orthophoric patients compared to those with esotropia and exotropia (p=0.027). Esotropic patients had lower VA compared to patients with exotropia, but this finding was not statistically significant (p=0.729). Presence of macular ectopia, retinal pathologies, and amblyopia were the most strongly correlated risk factors for strabismus development in ROP patients. DFD was not associated with severity of strabismus. Exotropia was mostly related to higher DFD and a possible relationship between esotropia and lower VA was observed.

Comparison between bupivacaine injection and mini-tenotomy in the management of horizontal small angle strabismus in children

ABSTRACT Purpose To compare the outcome of bupivacaine (BUP) injection vs mini-tenotomy of extra-ocular muscles in treating small angle horizontal strabismus in children. Methods A prospective comparative study that included a total of 40 patients. Twenty patients received 3 ml of 0.75% Bupivacaine (BUP) injection in both medial recti in case of exotropia and in both lateral recti in case of esotropia. MRI orbit was performed before and 30–60 days’ post injection of bupivacaine to estimate changes in muscle size. Mini-tenotomy was done in the other 20 patients, performed on both lateral recti in case of exotropia and on both medial recti in case of esotropia. Results Mean change of alignment at the end of 6 months in exotropic patients in bupivacaine group was 5.50 ± 4.10 PD and in esotropia patients 4.00 ± 3.38 PD with an average increase in muscle thickness of 0.12 mm ± 0.08 and 0.13 mm ± 0.09 in exotropia and esotropia, respectively. There was an average increase in volume 23 mm3 ± 17.3 and 17.00 mm3 ± 9.50 in exotropia and esotropia, respectively, as measured with MRI. The mean change of alignment in mini-tenotomy was 5.33 ± 4.12 PD, 5.75 ± 4.95 PD in exotropia and esotropia, respectively. Conclusion Bupivacaine and mini-tenotomy are safe and effective alternative treatment, that improved eye alignment in 65% of patients with small angle horizontal deviation.

Neuroimaging Findings in Acquired Esotropia Patients at Siriraj Hospital from 2009–2020

Objective: To analyze the neuroimaging findings in patients with acquired esotropia at Siriraj Hospital from 2009 to 2020. Materials and Methods: A retrospective review of the medical records of all patients aged above 6 months old who presented with acquired esotropia was done. All the patients had an angle of deviation 10 prism diopters (PD), refraction &lt; +3.0 diopters (D), and had neuroimaging performed. The patients with restrictive myopathy and extraocular neurological abnormalities were excluded from the study. Results: In total, 177 subjects aged between 8 months old to 81 years old (mean age 32.35 ± 24.40 years old) were included in the study. The patients’ demographic data, ocular findings, and neuroimaging findings were collected. The mean angle of deviation near and at distance were 26.88 ± 18.90 PD and 29.81 ± 17.25 PD, respectively. Of the 177 cases, 113 cases (63.8%) had no neuroimaging abnormalities, while 64 cases (36.2%) had abnormal neuroimaging findings. In those 64 cases with abnormal findings, there were 16 intracranial tumors, 6 inflammations, 4 vascular lesions, 7 degenerations, and 31 other lesions. Sixth nerve palsy was found to be significantly different between the positive and negative neuroimaging group from both the uni- and multivariate analysis. Conclusion: Although more than half of acquired esotropia patients had no abnormalities in neuroimaging, but 14.7% of those with abnormal neuroimaging findings had underlying serious conditions, which consisted of intracranial tumors, inflammation, and vascular lesions. Special attention should be concentrated to patients with sixth nerve palsy as it was the significant factor found to be associated with positive neuroimaging findings in acquired esotropia.

Призматическая коррекция остаточного или рецидивирующего косоглазия

Introduction. Recurrent strabismus is a common issue after operations because of heterotrophy. Many scientific works have examined clinical parameters that may predispose to relapse of esotropia after surgery, including poor sensory status, high ratio of accommodative convergence to accommodation, uncorrected farsightedness or combination of these factors. Purpose. To evaluate the effectiveness of prismatic correction of recurrent esotropia in patients after the first stage of surgical treatment. Material and methods. The study group included 24 patients. They were divided into two groups in depends on the postoperative functional treatment. 1st group consisted of 12 patients with partially accommodative esotropia aged 5 to 8 years (6,48 ± 1,12 years) with average hypermetropic refraction +3,10 ± 0,54 diopters. This group of patients was assigned prismatic correction after a relapse of esotropia. 2st group consisted of 12 patients with partially accommodative esotropia aged 5 to 8 years (6,22 ± 1,29 years) with average hypermetropic refraction +3,13 ± 0,61 diopters. This group of patients was assigned orthoptic treatment after a relapse of esotropia. Results. Prismatic correction contributed to recovery binocular vision at 75 % of patients with recurrent esotropia ≤ 20 PD, in the comparison group (orthoptic treatment) – at 50 %. Moreover, the number of patients with stereopsis in the group «EFP» after the treatment was higher than in the group «Synoptophore» (p &lt; 0,05). Conclusion. Prismatic correction ensures optimal motor status while maintaining sufficient sensory balance in most patients with recurrent esotropia after performing recession rectus medialis in combination with median duplication m. rectus lateralis. Keywords: Recurrent strabismus, binocular vision, elastic Frensel prism