Form Of Esotropia Research Articles

Muscle Transplantation for Large Angle Horizontal Strabismus.

Large angle sensory strabismus in the form of esotropia and exotropia often calls for bilateral surgery to correct the primary angle deviation. However, considering patients' reluctance to have surgery on the good eye, such large deviations may be managed with true muscle transplantation. The authors present a case series of four patients with large angle esotropia and exotropia who underwent unilateral true muscle transplantation as a single-stage procedure. [J Pediatr Ophthalmol Strabismus. 2020;57:e59-e62.].

Первичная гиперфункция нижних косых мышц

In the context of the development of modern strabismology debatable issues still remain, among which the most important and long-term is the choice of tactics for the treatment of primary hyperfunction of the inferior oblique muscle. This article presents a literature review of the most significant publications of national and foreign authors concerning this topic. Criteria of differential diagnostics of primary and secondary hyperfunction of the inferior oblique muscle are presented. The main pathophysiological mechanisms of its occurrence are identified: imbalance between the superior and inferior oblique muscles, horizontal muscle dystopia, as well as prolonged occlusion and prismatic correction. The epidemiology of primary hyperfunction of the inferior oblique muscle, which develops in patients under the age of 4 years in more than half of cases, is summarized. Congenital esotropia operated on toddlers is not a clear guarantee of success in the prevention of the development of the current pathology. Primary hyperfunction occurs equally in patients with accommodative and intermittent forms of esotropia, less often in cases of acquired esotropia. The analysis of different classifications of primary hyperfunction is provided. The indications for surgical treatment and the criteria for evaluation of its efficiency are considered. The mono- or bilaterality of hyper-elevation in adduction, its symmetry, the presence of a V pattern determine the tactics and methods of treatment, the choice of which depends on the degree of hypertropy in combination with horizontal deviation. Positive and negative aspects of the most frequently performed surgical interventions on the inferior oblique muscle; technical features of marginal myotomy, myoectomy, recession and anteriorization were evaluated.

Acute acquired comitant esotropia in children: A benign entity or an ominous sign?

Purpose: The purpose is to study the clinical features of acute acquired comitant esotropia (AACE) in children and analyze the course and outcome. Materials and Methods: A retrospective, clinical study of all patients under the age of 18 years with acute onset, nonaccommodative comitant esotropia in a tertiary eye care center from September 2013 to December 2016. Parameters studied were age, sex, visual acuity, eye involved, age of onset, precipitating event, amount of deviation, presence or absence of amblyopia, cycloplegic refraction, systemic involvement, surgical or nonsurgical intervention, course, and outcome. All patients underwent magnetic resonance imaging of brain and orbits, and systemic evaluation was done in suspicious cases. Minimum follow-up period was 6 months. Results: Out of 12 patients, 8 were male. Average age of the patients was 7.9 years. The mean esodeviation was 33.75 PD, and mean age of onset was 6.14 years (range: 2–15 years). There was left eye preponderance. Three patients (25%) had a history of a precipitating event. Cycloplegic refraction ranged from +0.50 DS to −6.75 DS, with majority having <+2.00 DS. Amblyopia was noted in 8 (66.6%) patients. Systemic involvement was seen in three patients in the form of ocular myasthenia, central nervous system glioma, and viral fever, respectively. Esotropia disappeared in one patient with overcorrected, high myopia following atropinization, and change of glass. Eight patients (66.6%) underwent strabismus surgery with good postoperative alignment, and the rest were managed conservatively. Conclusion: AACE is an unusual ocular alignment disorder characterized by a nonaccommodative esodeviation which can occur in older children, adults, and even the elderly. Although most children with this form of esotropia are otherwise healthy, systemic diseases must be considered and ruled out before planning surgery. Prompt amblyopia therapy and timely surgery can result in a satisfactory outcome in those without systemic involvement.

Evaluation and Management of Acute Acquired Comitant Esotropia in Children

ABSTRACTAcute acquired comitant esotropia (AACE) is characterized by a sudden-onset eye misalignment with an equal angle of deviation in all fields of gaze. This form of esotropia is distinct from common forms of childhood esotropia, such as infantile esotropia and accommodative esotropia, in the rapid tempo and typically later timing of onset; further, AACE is distinct from restrictive or paretic strabismus, which usually results in an incomitant angle of deviation that varies with the direction of gaze. The underlying etiologies for AACE are broad but, in some cases, it may be associated with significant neurologic disease. Therefore, the purpose of this article is to examine and summarize the current literature on AACE to provide a framework for the evaluation and management of this form of acquired strabismus.

Intermittent Exotropia and Mental Illness

Background and PurposeAlthough adverse psychosocial effects are well documented among patients afflicted with strabismus, recent studies have shown that children with intermittent exotropia, unlike the more prevalent forms of esotropia, are at an increased risk for developing frank mental illness by early adulthood. The purpose of the study was to provide a brief overview of current findings regarding the nonophthalmic aspects of this common condition.Patients and MethodRecent reports will be reviewed regarding psychosocial effects and mental illness among children with intermittent exotropia.ResultsChildren with intermittent exotropia have been shown to have a nearly three-fold increased incidence of developing mental illness, compared to controls, by the third decade of life. Moreover, males had significantly more mental health morbidity than females. Although quality of life measures have demonstrated improved psychosocial outcomes among children who underwent successful strabismus surgery, frank mental illness appears to be less amenable to such intervention.ConclusionIn addition to the adverse psychosocial affects observed in children with strabismus, intermittent exotropia, especially among boys, appears to confer a specific risk for developing frank mental illness. Clinicians managing such patients should consider the entire physical and psychological aspects of this condition and develop strategies for minimizing adverse psychosocial outcomes.

Esotropia and hyperopia corrected

The subgroups of esotropia exist. The full optical correction of the hypermetropic refractive error is theoretically conclusive. The full correction further defined the diagnosis of three forms of esotropia. The earlier viewpoint that the full optical correction of the hypermetropia will decrease the accommodative normal demand or the accommodation is inactive and an exotropia will increase. After full correction of the hypermetropia the patients often complain about blurring of vision. Moreover, some doctors still have a confused ideas about full correction of the hyperopia. The final outcome that of most of patients with under-corrected hypermetropia, three commonly forms of esotropia (Accommodative esotropia, partially accommodative esotropia and nonaccommodative esotropia) will not be clearly differentiated as each requires different clinical management.

Clinical Characteristics and Surgical Treatment of Intermittent Esotropia/Clinical Characteristics and Surgical Treatment of Intermittent Esotropia: Discussion

This study describes the age of onset, symptomatology, and clinical characteristics of 25 patients with intermittent esotropia. This subgroup of esotropic patients typically has onset prior to 10 years of age and shows excellent bifoveal fixation ability, reflected by a high degree of stereopsis. In contrast to patients with other forms of esotropia, there is minimal to no hyperopia, an average esodeviation of approximately 20 prism diopters, and a low incidence of amblyopia, DVD, and oblique overaction. Symptomatic diplopia or cosmetic concern necessitated surgical intervention in 17 (68%) patients. Fifteen (88%) patients had good or excellent surgical results of either orthophoria, esophoria, or residual esotropia of 10 delta or less. One patient (6%) had residual esophoria greater than 10 delta. One patient had 4 delta of exophoria postoperatively. Intermittent esotropia should be differentiated from the various entities of microtropia, fixation disparity, and monofixation syndrome.

Bowman lecture. Current concepts of infantile esotropia.

Several forms of esotropia with a different pathophysiology that meet the criterion of an onset early in life must be distinguished from essential infantile esotropia. A hypothesis is presented, according to which a delayed development or a congenital defect of retinal disparity sensitivity (motor fusion) in an otherwise normal infant with immature sensory functions causes esotropia under the influence of various strabismogenic factors. Some of these factors are genetically determined, hence the familial occurrence of essential infantile esotropia. The absence or marked decrease of stereopsis and the asymmetry of optokinetic nystagmus are interpreted as the consequence of ocular misalignment early in life rather than of structural anomalies in the afferent visual pathways of esotropic patients. The therapeutic results after surgery are classified into four groups: subnormal binocular vision, microtropia, small angle eso- or exotropia and large angle residual or consecutive eso- or exodeviations. Analysis of data from 358 operated patients with a documented onset of esotropia prior to the sixth month of life has shown that the probability of obtaining an optimal functional result is increased when surgical alignment is completed before completion of the second year of life. However, surgery after the age of two or even four years of life does not preclude the development of binocular vision on a subnormal or anomalous basis.

A Reassessment of Infantile Esotropia XLIV Edward Jackson Memorial Lecture

Essential infantile esotropia is an early acquired, not a congenital, condition, although congenital factors may favor its development between the ages of 3 and 6 months. It must be distinguished from other forms of esotropia with an onset between birth and the first six months of life. The cause of essential infantile esotropia remains unknown, but advances in our knowledge can be expected from the rapidly emerging discipline of infant psychophysics. In analyzing treatment results, a clear distinction must be made between normal, subnormal, and anomalous forms of binocular cooperation. While complete restoration of normal binocular function is rarely, if ever, achieved, anomalous binocular cooperation has many functional advantages over suppression or diplopia and should not be disturbed by overzealous treatment. Subnormal binocular vision is considered to be an optimal, microtropia a desirable, and a residual small angle heterotropia an acceptable end stage of surgical therapy. In a study of 358 surgically treated patients with a documented onset of essential infantile esotropia before age 6 months, subnormal binocular vision was present in 71 (20%), a microtropia in 25 (7%), and a small angle esotropia or exotropia in 140 (39%) of the patients. Surgical alignment before completion of the second year of life improved the chances for an optimal treatment result.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemispheric visually-evoked responses in congenital esotropia.

We studied 42 infants with congenital esotropia with and without abducting nystagmus. Hemispheric visually-evoked potentials did not document any asymmetry of the retinogeniculostriate projections similar to those documented in albinotic animals and humans. This study does not substantiate the thesis that some forms of esotropia may be due to genetically determined anomalies of the anterior visual pathways.