Surgical Outcomes Of Acute Acquired Concomitant Esotropia

PurposeTo analyze the surgical outcomes of patients who diagnosed with AACE.MethodsRetrospective study.Patients diagnosed with acute acquired concomitant esotropia,who underwent strabismus surgery in the Department of Strabismus and Pediatric Ophthalmology,Eye Center,Second Hospital of Jilin University between January 2016 and August 2021 were included.All patients received general ophthalmological examination and strabismus specialist examination before operation.Patients with intracranial lesions,trauma,systemic diseases including hyperthyroidism,diabetes and myasthenia gravis which may cause esotropia,and patients with a history of strabismus or eye surgery were excluded.The following data were collected: basic personal information,binocular ametropia,time of near work,pre-and postoperative esodeviation angles at distance and near,pre-and postoperative near stereopsis and diplopia,accommodative convergence to accommodation（AC/A）,the amount of extraocular muscle surgery and other data.The main outcome measures were final sensory and motor success rate after surgery.Motor success was considered as alignment within 8 prism degrees（PD）at both near and distance.The successful sensory outcome was defined as absence of diplopia in primary gaze after operation.Stereoscopic recovery was defined as absence of coarse stereopsis preoperatively and stereoacuity≤800 sec/arc at near postoperatively.A rank test was used to compare the difference in esodeviation before and after strabismus surgery.Pre-and postoperative near stereopsis and diplopia were analyzed by the Chi square test.Results1.Among the 86 patients diagnosed with AACE,33 of them were female and the rest were male.The median age was 18（11.25）years old.The median follow-up period was 6（19）months.All patients had performed near-work 10（2.5）hours per day.Among all the patients,the preoperative esodeviation angles at distance were bigger than near or both equal.2.After the first surgery,76 patients got both motor and sensory success.The total surgical success rate was 88.37%（76/86）.There were 23 cases whose preoperative esodeviation angles were smaller than 30 PD.They underwent single extraocular muscle operation and obtained the surgical success rate of 65.22%（15/23）.Among them,14 cases underwent unilateral medial rectus recession.The surgical success rate was 71.43%（10/14）.9 cases underwent unilateral lateral rectus resection.The surgical success rate was 55.56%（5/9）.The difference between them was not statistically significant（P=0.657,P>0.05）.There were 61 cases whose preoperative esodeviation angles were between 30 PD and 75 PD.They underwent unilateral medial rectus recession combined with a lateral rectus resection in the same eye and obtained the surgical success rate of 96.72 %（59/61）.There were 2 cases whose preoperative esodeviation angles were bigger than 75 PD.Both of them underwent bilateral medial rectus recession combined with unilateral lateral rectus resection and obtained surgical success.The surgical success rate was 100%。3.The median preoperative esodeviation angle of success group was45（35～65）PD at distance,while failure group was 30（25～35）PD.The difference between them was statistically significant（Z=-2.653,P=0.008,P<0.05）.The median preoperative esodeviation angle of success group was 40（26.25～60）PD at near,and failure group was 20（15～28.75）PD.The difference between them was statistically significant（Z=-2.939,P=0.003,P<0.05）.4.The stereoscopic recovery rate was 83.08%（54/65）.52 cases showed the successful recovery of stereopsis a week after the operation,while 2 cases recovered a month later.ConclusionsThe surgical outcomes of AACE would be successful when the suitable extraocular operation is applied.The sensory and motor outcomes of unilateral medial rectus recession with lateral rectus resection were favorable for patients whose preoperative esodeviation angles were between 30 PD and 75 PD.To achieve better surgical outcomes in AACE cases whose preoperative esodeviation angles smaller than 30 PD,targeting postoperative orthotropia by increasing the amount of medial rectus recession or lateral rectus resection is recommended.Most AACE cases show the successful recovery of stereopsis after correction esotropia by surgery early.