| BackgroundAcute acquired concomitant esotropia(AACE)is a special group of concomitant esotropia which has an acute process of occurrence after the sensitive period of visual development.Although the clinical examination of strabismus has no significant difference between AACE and other common esotropia(the differences in the squint angle of different positions of gaze are less than 5Δ),there is a significant discrepancy between AACE and other common esotropia,that patients with AACE often have diplopia,confused vision and other clinical symptoms.In recent years,with the popularity of intelligent electronic terminals,the incidence of AACE has a trend of increasing,attracting a lot of domestic and foreign scholars to study it.Burian and Miller first defined three main types of AACE:(1)Swan type:acute esotropia caused by monocular occlusion and other fusion interruption factors;(2)Franceschetti type:concomitant esotropia characterized by mild hyperopia and diplopia,often associated with physical or psychological stress in adolescents and young patients;(3)Bielscowsky type(BE):the most common subtype of AACE occurs in patients with myopia from adolescence to old age,and its risk factors include mild-tomoderate myopia,long-term massive near vision work,and anatomical position of extraocular muscles.In this paper,we deeply analysis and discuss the etiology、applicable surgical methods、prognosis、recurrence risk factors of AACE,to explore the etiology and effective treatment of AACE.ObjectiveThis paper analyzes the case characteristics,surgical effect and visual function recovery of AACE,to explore the etiology,risk factors and the best treatment methods,in order to provide a reference for diagnosis,treatment choice and other clinical work.Materials and MethodsA total of 52 AACE patients with complete data were collected from the Department of Ophthalmology,Qilu Hospital of Shandong University from January 2017 to July 2022.Among them,49 patients underwent surgical treatment and 3 patients received prism correction.Clinical data such as gender,age of onset,refraction,stereopsis,strabismus prism diopter,AC/A value,body mass index(BMI),and daily time of near visual work in the first half year before the onset were recorded,and the characteristics of AACE cases were retrospectively analyzed.Follow-up and clinical data were collected after treatment to evaluate the therapeutic effect.The risk factors of AACE recurrence were analyzed by comparing the patients with recurrence and non-recurrence during the follow-up period after surgical treatment.SPSS software was used for statistical analysis.Results1.A total of 52 eligible patients with acute concomitant esotropia were collected,including 35 males and 18 females.The average age is 21.35±9.39 years,the average value of spherical equivalent is OD:-4.45±2.25)D;OS:-4.13±2.27)D,the average degree of anisometropia was 0.79±1.59)D,and the average time of daily near vision work was 8.76±2.06h.35 patients(66.38%)self-reported the cause of "excessive eye use" before onset of diplopia.2.The mean value of the prism degree at distance was 30.23 ±12.02 Δ,while the mean value of the prism degree at near was 28.06±14.18Δ.And the mean AC/A value was 5.66±1.96.The prism degree at distance was higher than that at near(t=2.605,P=0.012).3.There were 33 cases(62.26%)with stereopsis,and the mean value of stereopsis acuity was 330.30±238.24 ",20 cases(37.74%)without stereopsis.All 52 patients were diplopia on Worth four-light examination.4.One case(1.89%)had abnormal brain CT examination.5.There were no statistically significant differences in far strabismus、near strabismus and AC/A values among different degrees of myopia.6.Wearing triple prism was used at 3 patients,and diplopia was eliminated after treatment.Two patients without stereopsis respectively recovered to 800"and 400" stereopsis acuity.And one patient’s stereopsis acuity is 100" without triple prism,while it turn to 60"after wearing triple prism.7.49 patients received surgical treatment,and 44 cases(89.80%)returned to mcsoropter.After operation,the mean value of prism degree was 3.18 ± 3.69 Δ at distance and 2.51 ± 4.85Δ at near.There were 17 cases without stereopsis before operation,and 12 cases of them recovered stereo vision after operation(70.59%).The 32 patients with stereovision whose mean stereopsis acuity was 337.50±241.58 before operation,and the quantitative value is 196.56 ±171.44 after surgery.8.Reexamination found 6 cases(12.50%)of recurrence,and the postoperative recurrence time is 8.00±5.80 months.In the recurrence group,the average age of onset is 25.50 ± 17.49 years old,the average time of course of disease is 45.00 ±43.56 months,the BMI is 24.23 ±6.09 kg/m2,and the average degree of anisometropia is 2.06±4.26D.In the non-recurrence group,the average age of onset is 20.50 ±8.08 years old,the average time of course of disease is 24.15 ±24.94 months,the BMI was 21.90 ±3.61 kg/m2,and the average degree of anisometropia is 0.62±0.80D.The the average degree of anisometropia in the recurrence group was greater,and the difference was statistically significant(t=2.16,P=0.035).Compared with the non-recurrence group,the recurrence group have larger age of onset,preoperative disease duration and BMI,however these difference are non-significant(P>0.05).Conclusions1.Excessive near vision work may be a risk factor for the onset of AACE.2.Patients with minor degree AACE can eliminate diplopia and restore stereoscopic function through prism correction.3.Surgical treatment of AACE has good curative effect,and the stereopsis function can be recovered quickly and well after surgery.4.There is a certain risk of recurrence after AACE surgery,and anisometropia may be a relapsing-related risk factor. |
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