Magnetic resonance imaging of extraocular rectus muscles abnormalities in acute acquired concomitant esotropia

AIM:To investigate the difference of medial rectus(MR)and lateral rectus(LR)between acute acquired concomitant esotropia(AACE)and the healthy controls(HCs)detected by magnetic resonance imaging(MRI).METHODS:A case-control study.Eighteen subjects with AACE and eighteen HCs were enrolled.MRI scanning data were conducted in target-controlled central gaze with a 3-Tesla magnetic resonance scanner.Extraocular muscles(EOMs)were scanned in contiguous image planes 2-mm thick spanning the EOM origins to the globe equator.To form posterior partial volumes(PPVs),the LR and MR cross-sections in the image planes 8,10,12,and 14 mm posterior to the globe were summed and multiplied by the 2-mm slice thickness.The data were classified according to the right eye,left eye,dominant eye,and non-dominant eye,and the differences in mean cross-sectional area,maximum cross-sectional area,and PPVs of the MR and LR muscle in the AACE group and HCs group were compared under the above classifications respectively.RESULTS:There were no significant differences between the two groups of demographic characteristics.The mean cross-sectional area of the LR muscle was significantly greater in the AACE group than that in the HCs group in the non-dominant eyes(P=0.028).The maximum cross-sectional area of the LR muscle both in the dominant and non-dominant eye of the AACE group was significantly greater than the HCs group(P=0.009,P=0.016).For the dominant eye,the PPVs of the LR muscle were significantly greater in the AACE than that in the HCs group(P=0.013),but not in the MR muscle(P=0.698).CONCLUSION:The size and volume of muscles dominant eyes of AACE subjects change significantly to overcome binocular diplopia.The LR muscle become larger to compensate for the enhanced convergence in the AACE.

Botulinum toxin type A in treating early-stage patients with small-angle acute acquired comitant esotropia

AIM:To investigate botulinum toxin A(BTXA)efficacy on small-angle(≤25Δ)acute acquired concomitant esotropia(AACE)in early-stage patients.METHODS:The electronic medical record data of AACE patients during March 2019 and June 2023 were collected in this retrospective and hospital-based cohort study.A total of 72 small-angle AACE patients received BTXA extraocular muscle injection.Patients were grouped by onset-to-treatment time(Group A:≤6mo,Group B:>6mo).Deviation of esotropia,eye alignment and stereopsis were analyzed at the period of pre/post-injection(1wk,1,3,and 6mo).Orthophoria rate at 6mo(horizontal deviation<10Δand binocular single vision)were considered as outcome index.RESULTS:There were no significant baseline differences(P>0.05)between two groups except onset-to-treatment time(2mo vs 11mo,P<0.001).Higher orthophoria rates were in Group A at last follow-up(94.74%vs 73.53%,P=0.013).Post-BTXA deviations of two groups at 1mo showed no difference(P>0.05);while in 3 and 6mo Group A was significantly smaller than group B(all P<0.001).No statistically significant differences were observed among all post-BTXA deviations of near and distance in Group A.In Group B,deviation at 3mo(near:2Δvs 0,P<0.001;distance:4Δvs 0,P<0.001)and 6mo(near:6Δvs 0,P<0.001;distance:6Δvs 0,P<0.001)was significant increased compared to deviation at 1wk after treatment.Group A showed better stereopsis recovery in last follow-up compared to Group B(80″vs 200″,P=0.002).Both groups obtained improved stereopsis after treatment(Group A:80″vs 300″,P<0.001;Group B:200″vs 300″,P=0.037).CONCLUSION:BTXA is effective for AACE with small deviation(≤25Δ)in early stage.Delayed treatment(>6mo)may reduce BTXA efficacy.Early BTXA intervention benefits long-term eye alignment and stereopsis recovery.

Analysis of independent risk factors for acute acquired comitant esotropia

comitant esotropia(AACE).METHODS:A retrospective cohort study was conducted by analyzing 83 patients(case group)with AACE who underwent strabismus correction surgery from January 1,2021 to June 30,2022.Totally 73 outpatient volunteers were recruited during the same period as the normal control group.The case group’s binocular vision time,near and distance esotropia angle,and near stereo vision function were recorded,and the age,gender,refractive status,and best-corrected visual acuity(BCVA)of both groups were analyzed.Additionally,multiple logistic regression analysis was conducted using an eye usage condition questionnaire to determine the independent risk factors for AACE.RESULTS:In the case group,61 patients(73.49%)had myopia,with a mean equivalent spherical power(SE)of-3.35±3.31 D(range:+2.75 to-10.62 D)of the right eye and-2.87±3.35 D(range:+2.75 to-11.12 D)of the left eye.The average duration of diplopia in the case group was 29.83±35.72mo,of which 80 patients(96.39%)were primarily with distance diplopia.The near and distance esotropia angle after wearing glasses were 52.36±20.95 prism degree(PD)and 56.71±19.54 PD,respectively,and there was no statistically significant difference between the two(t=1.38,P=0.169).The incidence of improper glasses wearing and unhealthy eye habits in the case group was significantly higher than those in the control group(P<0.05).Close-up work without glasses[β=2.30,odds ratio(OR)=10,95%confidence interval(CI)2.35-42.51,P=0.002]and near work in supine position(β=1.80,OR=6.02,95%CI 3.29-11.02,P<0.001)were independent risk factors for AACE.CONCLUSION:Patients with AACE mainly present with distance diplopia,and there is a high degree of variation in myopia.Near work without wearing glasses and in supine position are independent risk factors for AACE.

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

AIM:To assess metrics of diffusion tensor imagining(DTI)in evaluating microstructural abnormalities of horizontal extraocular muscles(EOM)in esotropia.METHODS: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.RESULTS: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 mm^(2)/s vs 0.207×10-2 mm^(2)/s,P=0.014;0.182×10-2 mm^(2)/s vs 0.152×10-2 mm^(2)/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 mm^(2)/s vs 0.266×10-2 mm^(2)/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 mm^(2)/s vs 0.593×10-2 mm^(2)/s,P=0.013).No statistically significant differences were present between the adducted and fixating eyes in concomitant strabismus patients.CONCLUSION: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.

Acute acquired concomitant esotropia with congenital paralytic strabismus:A case report

BACKGROUND An unusual case of acute acquired concomitant esotropia(AACE)with congenital paralytic strabismus in the right eye is reported.CASE SUMMARY A 23-year-old woman presented with complaints of binocular diplopia and esotropia of the right eye lasting 4 years and head tilt to the left since 1 year after birth.The Bielschowsky head tilt test showed right hypertropia on a right head tilt.She did not report any other intracranial pathology.A diagnosis of AACE and right congenital paralytic strabismus was made.Then,she underwent medial rectus muscle recession and lateral rectus muscle resection combined with inferior oblique muscle myectomy in the right eye.One day after surgery,the patient reported that she had no diplopia at either distance or near fixation and was found to be orthophoric in the primary position;furthermore,her head posture immediately and markedly improved.CONCLUSION In future clinical work,in cases of AACE combined with other types of strabismus,we can perform conventional single surgery for both at the same time,and the two types of strabismus can be solved simultaneously.

More to it than meets the eye: a case report of incomitant esotropia in a child caused by a giant basilar aneurysm

Background:Esotropia is a common concern in pediatric ophthalmology consultations.While most cases stem from strabismus,it is crucial for physicians to differentiate atypical features that might indicate underlying organic causes,such as VI nerve palsy,hinting at the presence of intracranial spaceoccupying lesions.Although the occurrence of cerebral aneurysms in children is rare,they can have severe consequences.Case Description:Here,we described an extremely rare case of giant basilar fusiform aneurysm measuring 4.0 cm×3.9 cm×3.9 cm in an otherwise healthy 8-year-old child,and analyzed its atypical features that suggested an intracranial etiology.We further described an endovascular approach,performed by interventional radiologists,and discussed its advantages over the conventional neurosurgery.The patient continued to be followed by our multidisciplinary team.He had a stable post-operative course and made an excellent recovery neurologically.At the 1-year follow-up,he was orthophoria with excellent vision and stereopsis.Conclusions:To our knowledge,this is the first pediatric case in Canada where a giant intracranial aneurysm was treated endovascularly.The salient red flags—progressive incomitant esotropia and diplopia,the presence of myopia(rather than hyperopia),nystagmus and abnormal saccadic movements—should be astutely recognized by clinicians as intracranial giant aneurysms carry a poor prognosis.A multidisciplinary approach is essential for the management of such cases.

A型肉毒毒素与眼外肌手术治疗大角度急性共同性内斜视的疗效对比

目的:探讨A型肉毒毒素(BTA)注射和眼外肌手术治疗大角度(≥+60 PD)急性共同性内斜视(AACE)的疗效差异性。方法:回顾性分析2020-06/2022-12于我院治疗的AACE患者60例的临床资料,根据治疗方式分为2.5 IU BTA注射组(14例)、5.0 IU BTA注射组(29例)、手术组(17例)。治疗后随访6 mo,观察纳入患者屈光矫正后的斜视度、视功能、治疗有效率及BTA注射后并发症发生情况。结果:治疗后6 mo,手术组和5.0 IU BTA注射组患者的斜视度均小于2.5 IU BTA注射组(P<0.017),但手术组与5.0 IU BTA注射组患者的斜视度无显著差异(P>0.017);5.0 IU BTA注射组有效率高于2.5 IU BTA注射组(86%vs 43%,P<0.017);三组患者各级视功能均无差异(P>0.05);2.5 IU BTA注射组和5.0 IU BTA注射组治疗后并发症总发生率无显著差异(43%vs 52%,P>0.05)。结论:对于斜视度≥+60 PD的AACE患者,双眼内直肌注射5.0 IU BTA可以取得与传统眼外肌手术相当的效果,且其具有创伤小,操作简单方便的优势。

不同年龄段急性获得性共同性内斜视的临床特征

目的:分析不同年龄段急性获得性共同性内斜视(AACE)患者的临床特征。方法:回顾性临床病例研究。连续纳入2015-01/2022-12在北京大学人民医院手术的非Ⅰ型(AACE)患者112例。收集的患者信息包括:性别、年龄、发病年龄、手术年龄、发病持续时间(手术与发病的时间间隔)、屈光度、发病前6 mo每日近距离用眼时间、术前及术后1 mo三棱镜斜视度及Titmus近立体视。将患者按年龄分为<18岁组22例,18-45岁组67例,>45岁组23例。比较各组患者的临床资料特点。结果:共纳入患者112例,其中男56例,女56例,手术年龄为29.50(19.25,41.75)岁,近视患者97例(86.6%)。发病前6 mo每日近距离用眼时间>8 h患者93例(83.0%)。年龄<18岁组患者发病持续时间为1.00(0.50,1.00)a,右眼屈光度为-0.75(-3.19,-0.56)D,左眼为-1.25(-2.81,-0.75)D,术前看近斜视度为30.00(18.50,80.00)PD,看远斜视度为35.00(23.75,80.00)PD,较其余两组比较均有差异(均P<0.05)。18-45岁组患者术前看近斜视度为20.00(14.00,30.00)PD,看远斜视度为25.00(20.00,35.00)PD,两者均较年龄>45岁组大(均P<0.05)。年龄>45岁组术后1 mo看近斜视度为-4.50(-7.50,0)PD,术后1 mo看远斜视度为4.50(0,9.50)PD,较其余两组更小(均P<0.05)。>45岁组患者手术成功率最高(100%)。术前立体视>45岁组比<18岁组患者更好(P<0.05),术后1 mo立体视18-45岁组、>45岁组均好于<18岁组(均P<0.05)。结论:AACE手术患者主要在18-45岁,斜视度特点为看远斜视度比看近大。术前年龄<18岁的患者斜视度较成人更大,但术后早期立体视较成人差。对于18-45岁AACE患者可适当增加手术量(5-10 PD),低龄远视、术前双眼视功能尚未建立的儿童,适当保守设计。

Ⅲ型急性共同性内斜视的发病机制及治疗研究进展

Ⅲ型急性共同性内斜视多发生于青春期后的近视患者中。这种类型的斜视具体发病机制尚不明确,可能与近视、集合-发散失衡、过度调节、内隐斜的失代偿、异常的解剖结构及视觉中枢功能异常有关,目前的主要治疗方法包括手术、注射肉毒素、配戴三棱镜、视功能训练,本文主要就Ⅲ型急性共同性内斜视的发病机制和治疗进展展开综述。

压贴三棱镜联合手术矫正共同性内斜视疗效观察

目的:探讨压贴三棱镜联合手术治疗共同性内斜视矫正的效果。方法:回顾性分析笔者医院2018年5月-2020年6月60例共同性内斜视患儿临床资料,将给予压贴三棱镜并接受斜视矫正手术治疗的患儿纳入A组,将采用单纯手术治疗的患儿29例纳入B组,比较两组矫正效果、双眼视功能以及眼球屈光度。结果:A组术后3个月正位率93.55%高于B组68.97%(P<0.05);两组治疗后同时视功能比较,差异无统计学意义(P>0.05);A组术后1个月、术后3个月有融合功能比例分别为64.52%、74.19%高于B组37.93%、48.28%(P<0.05);A组术后7 d、术后1个月、术后3个月平均融合范围大于B组(P<0.05);A组术后1个月、术后3个月近立体视功能优于B组(P<0.05);两组治疗后柱镜屈光度、球镜屈光度、散光值、散光轴位比较,差异无统计学意义(P>0.05)。结论:共同性内斜视矫正术前联合使用压贴三棱镜提高了术后正位率,增强了术后融合功能和立体视功能恢复效果,不影响眼球屈光度。

马氏杆试验在急性共同性内斜视临床诊治中的应用

目的探讨术中利用马氏杆精准指导治疗急性共同性内斜视患者的效果评价。方法对2020年1月至2022年9月南昌大学第一附属医院收治的43例AACE患者,术前应用马氏杆联合三棱镜行斜视度测定,术中应用马氏杆点线重合原理指导调整手术量,并评价其术后效果。结果研究对象手术平均年龄(22.56±8.93)岁,发病至手术的平均时间(38.56±26.42)个月,术前远距斜视度平均为(63.28±20.42)PD,近距斜视度平均为(52.67±24.08)PD,所有患者术前均有不同程度复视。43例患者经手术治疗后随访三个月,角膜映光法检查恢复正位,马氏杆联合三棱镜检查斜视度平均为0(-3,0)PD,除1例患者视远有复视,其余患者术后复视均消失,手术成功率高达97%,手术前后患者斜视度比较差异有统计学意义(P<0.05)。结论马氏杆联合三棱镜检查术前可查出需要矫正的最大斜视度,马氏杆术中能精准地指导矫正AACE手术量,从而获得满意的眼位矫正效果,复视情况也能得到明显改善。

急性获得性共同性内斜视的临床分析及手术探讨

目的探讨急性获得性共同性内斜视的临床特征、病因及手术治疗的方式与效果。方法回顾性病例研究。收集2019年5月至2023年3月在合肥普瑞眼科医院由同一主刀医生手术治疗的59例急性获得性共同性内斜视患者,对其眼部全面检查、新斯的明试验、排除外伤史、弱视治疗遮盖史,CT或MRI检查排除头颅及眼眶疾病系统分析后,综合看远和看近的斜视度数及主导眼,设计全矫手术方案,观察其手术治疗前后复视情况、眼位、眼球运动,同视机及Titmus图检查双眼同时视和立体视功能。结果59例患者经手术治疗:看远及看近无显斜,复视像均消失,眼球运动均正常,三棱镜+马氏杆检查:隐斜度数≤±10 PD(术后第1天:56例,术后1个月:53例,术后6个月:53例),+10 PD~+15 PD(术后第1天:3例,术后1个月:6例,术后6个月:6例);术前无同时视的患者均恢复同时视功能,所有患者立体视均比治疗前明显改善,随访6个月无1例斜视复发、未再出现复视。结论急性获得性共同性内斜视多发生在近视患者,且与近距离过度用眼有关,病程超过6个月的患者尽早实行手术治疗,术前充分评估斜视度、手术设计量要足,术毕效果达到近眼位外隐斜、远眼位内隐斜较好,术后患者复视消失,并恢复双眼视功能,达到满意疗效。

牵正散联合肉毒素及复方樟柳碱治疗目偏视临床研究

目的:评价牵正散加减联合A型肉毒素(BTA)眼外肌注射及复方樟柳碱颞浅皮下注射治疗目偏视的临床疗效。方法:收集诊断为目偏视(麻痹性内斜视)的患者79例(93眼),根据治疗方案分组:营养神经等基础治疗者27例(31眼)纳入对照组;基础治疗加用BTA眼外肌注射及复方樟柳碱颞浅皮下注射者28例(33眼)纳入注射组;注射组基础上加用牵正散加减者24例(29眼)纳入联合组。观察比较三组患者治疗前后三棱镜斜视度、患眼外直肌功能、临床症状评分、疗程及疗效。结果:治疗后三组患者斜视度、患眼外展功能、临床症状总评分均较治疗前好转,差异有统计学意义(均P<0.01);三组间患者斜视度、患眼外展功能、临床症状总评分改善差异有统计学意义(P<0.05),其中联合组较对照组和注射组改善更佳,差异有统计学意义(均P<0.05)。联合组治愈率(70.8%)高于对照组(44.4%)及注射组(35.7%),差异有统计学意义(P<0.05)。治愈者中联合组患者疗程更短,较其余两组差异有统计学意义(P<0.05)。结论:牵正散加减联合A型肉毒素眼外肌注射及复方樟柳碱颞浅皮下注射是治疗目偏视(麻痹性内斜视)的有效方法,可降低斜视度数、改善外直肌功能及临床症状评分、缩短疗程、提高治愈率。

利用屈光足矫和视功能训练治疗急性共同性内斜视案例分析

视功能训练是一种有效而安全的治疗急性共同性内斜视的方法,可以改善患者的症状和斜视度,提升3级视功能。分析1例采取屈光足矫、在院视功能训练等措施治疗的孕晚期急性共同性内斜视患者案例,评价视功能训练对该患者斜视度、融像范围和立体视功能的影响。患者在院接受了8次视功能训练后,双眼调节力、同时视、融像范围、立体视基本达到正常,取得了良好的治疗效果。由于重庆爱尔儿童眼科医院急性共同性内斜视病例数量较少,治疗观察时间短,还需进一步总结治疗经验。

Clinical efflcacy of botulinum toxin type A on acute acquired comitant esotropia

AIM: To investigate the effects of micro-injection of botulinum toxin A(BTXA) on acute acquired comitant esotropia(AACE). METHODS: A total of 33 AACE patients who underwent BTXA micro-injection at Renmin Hospital of Wuhan University from September 1^(st), 2019 to July 1^(st), 2021 were retrospective analyzed. Esotropia, eye alignment, stereopsis, and complications were examined at baseline(except complications), 1wk, 1, 3, and 6mo after injection. RESULTS: The average angle of deviation before injection was(+20.24±6.80)^(Δ) at near and(+24.76±6.43)^(Δ) at distance, while(+5.15±5.85)^(Δ) at near and(+7.30±6.17)^(Δ) at distance 6mo after treatment(P<0.05). Six months after injection, the stereopsis of patients had improved. The number of patients having no stereopsis(>800 seconds of arc) decreased from 11 to 3. The number of patients having peripheral stereopsis(300-800 seconds of arc), macular stereopsis(70-200 seconds of arc) and central concave stereopsis(≤60 seconds of arc) increased from 10 to 11, 10 to 12, and 2 to 7, respectively. At the follow-ups at 1wk, 1, 3, and 6mo after injection, success rates were 96.97%, 96.97%, 93.94% and 87.88%, respectively. One week after injection, two patients(6.07%) showed subconjunctival hemorrhage;three patients(9.09%) showed limited eye movement and one patient(3.03%) showed mild vertical strabismus. All the symptoms disappeared by the final follow-up.CONCLUSION: Micro-injection of BTXA can reduce diplopia and improve binocular vision function of AACE patients. Furthermore, the operation is relatively safe with few complications, making it an ideal treatment modality for AACE.

Three horizontal muscle surgery for large-angle esotropia: success rate and dose-effect ratio

AIM: To evaluate the moderate-term success and calculate the mean dose-effect ratio in large-angle esotropic patients who underwent three muscle surgery.METHODS: In a retrospective study, we reviewed the medical records of 37 patients with large-angle esotropia who underwent bilateral medial rectus recession and one lateral rectus resection. Sex, age at surgery time, amount of recessed or resected muscles in millimeter(mm), preand postoperative alignment in prism diopter(D), dose/response ratio, and presence of amblyopia and other associated vertical deviations were recorded.RESULTS: The mean age of subjects at surgery was 12.2±12.3 y(range: 1-57). The mean preoperative deviation of 70.4±8.1 D(range: 60-85 D) decreased to a mean of 5.4±8.1 D(range: 0-30 D) postoperatively(P<0.005). Successful alignment was achieved in 30 of 37 patients(81%) at a mean follow-up of 15.7±20.1 mo(range: 3-90). The mean amount of recession and resection was 17.59±1.29 mm, and a mean dose-response ratio of 3.79±81(range: 2.83-4.66) was determined.CONCLUSION: Three-muscle surgery for large-angle esotropia results in good moderate-term outcomes without high rates of overcorrection or undercorrection.

Clinical features and treatment of near-work-related acquired esotropia

AIM:To investigate the characteristics of near-workrelated esotropia and the clinical efficacy of botulinum toxin type A(BTXA)injection therapy on it.METHODS:A total of 107 patients aged 15-57y with near-work-related esotropia were taken as the BTXA-treated group,and 30 other peers without near-work-related esotropia were included in the control group.All participants were refractive corrected to analyse the clinical characteristics of near-work-related esotropia.All subjects were examined including Worth4 spot examination,stereoscopic vision,strabismus angle,accommodative convergence to accommodation ratio(AC/A),far and near positive and negative convergence,positive and negative fusion range,positive and negative relative accommodation.Clinical efficacy was evaluated at a period of 10mo follow-up.RESULTS:The distant and near stereopsis were found in 84.9%and 77.5%of patients in the BTXA-treated group,respectively.In the control group,all patients had distant and near stereopsis.The incidence of taking off one's glasses to see close objects was significantly higher in the BTXA-treated group than in the control group(P<0.05).The BTXA-treated group showed a smaller range of infusion(9.84±5.72)°than the control group(22.04±8.71)°(P<0.05).The near esotropia angle of the BTXA-treated group(17.08±11.98)△was significantly smaller than the distant esotropia angle(19.07±11.68)△(P<0.05).Ten months after injection,the diplopia and esotropia of most patients underwent improvements after treatment(P<0.05).CONCLUSION:This study reveals that the accommodation function and the habit of near work without wearing spectacles are associated with near-work-related esotropia,while the length of time for near work and the onset time are independent of near-work-related esotropia.Additionally,BTXA injection therapy plays a vital role in relieving diplopia and restoring eye position.

Essential infantile esotropia with inferior oblique hyperfunction：long term follow-up of 6 muscles approach

AIM： To evaluate long term follow-up （10y） of 6 muscle surgical approach in essential infantile esotropia （EIE）.METHODS： A 6 muscle approach to EIE was retrospectively evaluated in patients with inferior oblique （IO） hyperfunction and lateral rectus （LR） pseudoparalysis, who underwent surgery at different ages. Different clinical characters were analyzed pre- and postoperatively, in patients who underwent a 6 muscles approach ≤4 years of age. All patients underwent a multiple muscles approach： bilateral medial recti （MR） recession （4-5 mm）, bilateral LR resection （lower than 7 mm） and bilateral IO recession and anteroposition. Of 108 children with preoperative angle ≥＋30 prism diopters （PD） and IO hyperfunction were selected from larger cohort of patients （n=213, 103 females and 110 males） after excluding patients with： angle variability, who underwent reoperation and with incomplete follow up. Preoperative assessment and complete orthoptic examination were performed. Follow-up was performed 3mo, 2, 5 and 10y after surgery. Statistical analysis was performes using SAS statistical software package （version 9.1, SAS Institute Inc., Cary, NC, USA）.RESULTS： Ten years follow up data analysis showed the following percentage of orthotropic patients： （0 PD）： 3mo, 22.2%; 2y, 16.7%; 5y, 25.0% and 10y, 27.8%. A slight, significant （P〈0.01）, increase of 2y follow up residual deviation was found when compared to 3mo one. Stationary surgical results is reported during time, with a trend of mean residual deviation reduction （P=0.04）.CONCLUSION： Our results confirm the reliability of multiple muscles surgical approach in the treatment of patients affected by EIE with OI hyperfunction.

The relationship between abduction deficit and reoperation among patients with infantile esotropia

AIM： To determine the relationship between abduction deficit and reoperation among patients with infantile esotropia （IET）. METHODS： The records of 216 patients （432 eyes） with lET who underwent surgery, from 2010 to 2015 were studied. Patients with lET whose deviation appeared before 6mo of age and had stable preoperative deviation in two examinations with at least 2wk apart and a minimum 3too postoperative follow up were included. Cases with early onset accommodative esotropia, congenital cataract, retinopathy of prematurity （ROP）, manifest nystagmus, fundus lesions, neurologic and ophthalmic anomalies, 6th nerve palsy and Duane＇s syndrome were excluded. Preoperative abduction deficit was considered from -1 to -3 grading scale. Three months after surgery, children were classified into no-need reoperation [deviation〈15 prism diopters （PD）], and need-reoperation groups （deviaUon〉15 PD）. RESULTS： In this retrospective study, 117 female and 99 male patients with the mean surgical age of 4.7±6.4y were included. Reoperation rate was 33.3% and 16.0% in lET patients with and without abduction deficit, respectively in patients who had a history of late surgery. Abduction deficit increased the odds of reoperation by 82% [OR=1.82, 95% confidence interval （CI） =1.05 to 3.19, P=0.003] in patients who had a history of late surgery （〉2 years old, P=0.021）. Abduction deficit was improved significantly after operation （P〈0.001）. CONCLUSION： Based on our results, abduction deficit can be considered as a risk factor of reoperation in lET patients who are operated at the age of more than 2y.

Relation between preoperative hyperopia and surgical outcome in infantile esotropia

AIM: To evaluate the relation between preoperative hyperopia and surgical outcomes of infantile esotropia in patients younger than 24 months of age.METHODS: Medical records of patients who underwent bilateral medial rectus muscle recession for infantile esotropia between November 1, 2002 and December 1, 2011 were retrospectively reviewed. Patients were divided into two groups according to the degree of preoperative hyperopia. Group I had less than +3.0 diopter(D) of hyperopia and group II had between +3.0 and +5.0 D of hyperopia. Postoperative alignments were evaluated 1 wk, 3, 6 mo, and 1 y after surgery. Following the 1-year postoperative visit, patients were monitored yearly. Relationships between preoperative factors including hyperopia and postoperative outcomes were evaluated. RESULTS: Forty-six patients were included, with 33 patients in group I and 13 patients in group II. The preoperative mean refractive error was +0.88 D in group I and +3.45 D in group II. Surgical outcomes were not significantly different between groups at any postoperative time point examined. Cumulative probability of surgical success, prevalence of inferior oblique overaction, dissociated vertical deviation, and re-operation rate were not significantly different between groups.CONCLUSION: Preoperative moderate hyperopia(less than +5.0 D) did not affect the surgical outcome of infantile esotropia. Therefore, the surgical correction of esotropia should be considered when the angle of esodeviation is unchanged following hyperopia correction, even in children with moderate hyperopia.