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.

Biocompatibility of light responsive materials prepared for accommodative intraocular lenses manufacturing

AIM:To investigate the biocompatibility and bacterial adhesion properties of light responsive materials(LRM)and analyze the feasibility and biosafety of employing LRM in the preparation of accommodative intraocular lenses(AIOLs).METHODS:Employing fundamental experimental research techniques,LRM with human lens epithelial cells(hLECs)and human retinal pigment epithelium cells(ARPE-19 cells)were co-cultured.Commercially available intraocular lenses(IOLs)were used as controls to perform cell counting kit-8(CCK-8),cell staining under varying light intensities,cell adhesion and bacterial adhesion experiments.RESULTS:LRM exhibited a stronger inhibitory effect on the proliferation of ARPE19 cells than commercially available IOLs when co-cultured with the undiluted extract for 96h(P<0.05).Under other culturing conditions,the effects on the proliferation of hLECs and ARPE-19 cells were not significantly different between the two materials.Under the influence of light irradiation at intensities of 200 and 300 mW/cm^(2),LRM demonstrated a markedly higher inhibitory effect on the survival of hLECs compared to commercially available IOLs(P<0.0001).They also showed a stronger suppressive effect on the survival rate of ARPE-19 cells,with significant differences observed at 200 mW/cm^(2)(P<0.001)and extremely significant differences at 300 mW/cm^(2)(P<0.0001).Additionally,compared to commercially available IOLs,LRM had a higher number of cells adhering to their surface(P<0.05),as well as a significantly greater number of adherent bacterium(P<0.0001).CONCLUSION:LRM,characterized by their excellent non-contact tunable deformability and low cytotoxicity to ocular tissues,show considerable potential for use in the fabrication of AIOLs.These materials demonstrate strong cell adhesion;however,during photothermal conversion processes involving shape deformation under various light intensities,the resultant temperature rise may harm surrounding cells.These factors suggest that while the material plays a positive role in reducing the incidence of posterior capsule opacification(PCO),it also poses potential risks for retinal damage.Additionally,the strong bacterial adhesion of these materials indicates an increased risk of endophthalmitis.

Evaluation of corneal parameter changes under different accommodative stimuli with Scheimpflug imaging-based tomography

AIM:To evaluate the reliability of measurements of corneal changes with accommodation in healthy eyes using a Scheimpflug imaging-based system and how these measurements distribute in the normal population.METHODS:Prospective,non-randomized,comparative study including 27 healthy subjects(54 eyes),including emmetropia(13 eyes),myopia(17 eyes),hyperopia(4 eyes)and astigmatism(20 eyes)groups.In all cases,a complete eye examination was performed,including the analysis of corneal changes with different accommodative stimuli(+2.00,0.00 and-3.00 D)using the Pentacam AXL system.The investigation was structured in 2 phases:repeatability analysis and characterization of accommodation-related corneal changes in healthy populations.RESULTS:In the repeatability analysis,the index of height asymmetry(IHA)showed the greatest variability with the three accommodative stimuli,being the results for the rest of parameters acceptable.The group of emmetropes showed significant differences with accommodative changes in the position of maximum keratometry(Kmax;P<0.05),whereas in the astigmatism group,significant changes were not only observed in the position of Kmax,but also in minimum corneal thickness(MCT),corneal spherical aberration,and total and low order aberration root mean square(all P<0.05).Likewise,a significant difference was found in the displacement of the X position of Kmax with+2.00 D and-3.00 D in the myopia group(P=0.033)as well as in changes with+2.00 D and-3.00 D in the magnitude of the position vector of Kmax in the emmetropia group(P<0.05).No significant changes were found between accommodative stimuli in the displacement of coordinates of MCT(P≥0.109).CONCLUSION:The position of Kmax and MCT in healthy corneas can change significantly when presenting different accommodative stimuli using the accommodation mode of the Pentacam system,with different trends in these accommodation-related corneal changes between refractive errors.Likewise,the consistency of the measurements obtained with Scheimpflug has been confirmed.

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.

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.

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.

The role of clinical diagnosis criteria on the frequency of accommodative insufficiency

AIM: To estimate and compare the frequency of accommodative insufficiency(AI) within the same clinical population sample depending on the type of clinical criteria used for diagnosis. Comparing the frequency within the same population would help to minimize bias due to sampling or methodological variability. METHODS: Retrospective study of 205 medical records of symptomatic subjects free of any organic cause and symptoms persisting despite optical compensation evaluated. Based on the most commonly clinical diagnostics criteria found in the literature, four diagnostics criteria were established for AI(Ⅰ, Ⅱ, Ⅲ and Ⅳ) based on subjective accommodative tests: monocular accommodative amplitude two or more diopters below Hofstetter's minimum value [15-(0.25×age)](Ⅰ, Ⅱ, Ⅲ, Ⅳ); failing monocular accommodative facility with minus lens, establishing the cut-off in 0 cycles per minute(cpm)(Ⅰ) and in 6 cpm(Ⅱ, Ⅲ); failing binocular accommodative facility with minus lens, establishing the cut-off in 0 cpm(Ⅰ) and in 3 cpm(Ⅱ).RESULTS: The proportion of AI(95%CⅠ) for criteria Ⅰ, Ⅱ, Ⅲ and Ⅳ were 1.95%(0.04%-3.86%), 2.93%(0.31%-4.57%), 6.34%(1.90%-7.85%) and 41.95%(35.14%-48.76%) respectively, with a statistically significant difference shown between these values(χ2=226.7, P<0.001). A pairwise multiple comparison revealed that the proportion of AI detected for criterion Ⅳ was significantly greater than the proportion for the rest of the criteria(P-adjusted<0.05 in all cases).CONCLUSION: The prevalence of cases of AI within the same clinical population varies with the clinical diagnostic criteria selected. The variation is statistically significant when considering the monocular accommodative amplitude as the only clinical diagnostic sign.

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.

Y-splitting medial rectus muscle and recession in treatment for convergence excess esotropia

AIM: To evaluate the surgical outcome of medial rectus(MR) recession with Y-splitting procedure in treatment of esotropia with convergence excess.METHODS: Medical records were retrospectively reviewed for those patients who underwent surgical treatment for their convergence excess esotropia(CEET) between January 2018 and December 2020. Refractive error was examined by the equipment of the VS100(Welch Allyn). The surgical approach was bilateral MR recession with Y-splitting. The amount of recession was calculated according to the deviation angle at distance. Ocular movement and ocular alignment at distance and near were evaluated pre-and post-operatively. Binocular sensory status was evaluated by the Bagolini striated glasses at near and distance, and by stereoacuity assessment at near using the Titmus test.RESULTS: Six patients with CEET were included in this study. Four of them were hyperopia and two of them were myopia. A mean of eso-deviation angle at distance had been changed from 27.3±13.02 prism diopters(PD) preoperatively to 1.83±1.60 PD postoperatively(P<0.05), while a mean of eso-deviation angle at near had been changed from 50.00±20.74 PD preoperatively to 6.83±0.98 PD postoperatively(P<0.05). Patients had obtained binocular vision postoperatively.CONCLUSION: The surgical approach of Y-splitting MR and recession is effective in treatment of CEET.

Duplication of 19q (13.2-13.31) associated with comitant esotropia: A case report

BACKGROUND Comitant esotropia is the most common form of strabismus.It is caused by heterogeneous environmental and genetic risk factors.The pure duplication of the long arm of chromosome 19 is a rare abnormality.Only 8 patients with partial trisomy of the long arm of chromosome 19q have been reported to date.Here,we describe a girl with pure duplication of 19q,who was diagnosed with congenital esotropia,microcephaly,and gallbladder agenesis.CASE SUMMARY The patient was diagnosed with esotropia when she was 1-year-old.The Krimsky method showed+50 prism diopters in the primary gaze position.No additional abnormal findings were observed following slit lamp and fundus examination,but the features of the full-field electroretinogram showed a decreased amplitude and increased implicit times.Magnetic resonance imaging showed ventriculomegaly with thinning of the corpus callosum and splenium in her brain.A 4.42 Mb mosaic duplication within 19q13.2-q13.31 region(chr19:39,343,725 to 43,762,586)was detected by microarray comparative genomic hybridization.CONCLUSION Strabismus is reported in many live borns with pure duplication of 19q.This important clinical characteristic indicates that the candidate genes fundamental for this phenotype may be narrowed to genes within the 19q13.3-q13.31 region.There were two candidate genes observed that may contribute to the comitant esotropia phenotype,namely XRCC1(19:43,543,311)and SMG9(19:43,727,991).

Encouraging Visual Outcome of a New Accommodative Intraocular Lens: A Retrospective Long-Term Study with a Mean Follow-Up of 5.3 Years

Purpose: To assess the visual outcome after implantation of the new Hydrophylic IOL type 41 B/G accommodating intraocular lens (AIOL). Methods: The presented lens was implanted during cataract surgery. All patients were offered follow-ups, allowing two postoperative measurements to be performed at 3 months and between 2020 and 2021. The mean time between lens implantation and last follow-up was 5.3 years (min. 1 year, max. 10 years). Excluded were patients with age-related macular degeneration or amblyopia. Patients with a foreign lens implanted into the second eye were included in a separate control group. Corrected distance (CDVA) and uncorrected distance visual acuity (UDVA) at 5 m, and corrected near (CNVA) and uncorrected near visual acuity (UNVA) at 40 cm were assessed. Furthermore, the postoperative spherical equivalent (SE), the dependence on spectacles and the occurrence of optical phenomena were evaluated. Results: The final study cohort consists of 65 patients with 119 implanted AIOLs. Significantly better visual results were obtained in both postoperative follow-ups compared with the preoperative results. The mean values of the last follow-up for the UNVA, CNVA, UDVA, and CDVA were 0.107 ± 0.10;0.039 ± 0.08;0.097 ± 0.11;and 0.040 ± 0.09 logMAR, respectively. Visual outcomes remained on a high level for up to 10 years and showed significantly better results compared to the control group. Postoperative SE was significantly improved. Nearly 70% of patients were no longer dependent on glasses. Furthermore, the occurrence of disturbing optical phenomena was denied by all patients. Conclusion: The results of this AIOL are particularly promising, especially since gratifying visual results could still be measured 10 years after implantation.

Botulinum toxin augmentation as a sequential procedure for residual esotropia in traumatic sixth nerve palsy

Dear Editor, We want to describe the surgical outcome of a patient with residual esotropia due to sixth nerve palsy with re-resection of the lateral rectus combined with botulinum toxin injection to previously recessed ipsilateral medial rectus.Sixth nerve palsy may be vasculopathic, traumatic, neoplastic,

Abruptly developed large esotropia after full time occlusion therapy in anisometropic amblyopia

Dear Sir,I am Dr. Huijae Lee, from the Seoul Ire Eye Clinic,Seoul, Korea. I write to present a case report of esotropia after occlusion therapy.Amblyopia can be caused by