Yan Jianhua, Wen Yun
Zhongshan Ophthalmic Center, The State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China.
J Craniofac Surg. 2017 Sep;28(6):e513-e515. doi: 10.1097/SCS.0000000000003631.
PURPOSE/BACKGROUND: Cyclic esotropia is a rare condition that mostly occurs in children, characterized by patterns of straight and strabismic days with a regular cycle of 24 to 96 hours. In this report, 2 patients of cyclic esotropia in adults who showed a regular 48-hour cycle of mild deviation on 1 day followed by a more severe deviation on the second day are presented.
Clinical reports, clinical features, imaging findings, and surgical outcomes are presented.
In patient 1, a 42-year-old male with high myopia was diagnosed with progressive esotropia for 2 years. A medial and lateral rectus (LR) recession/resection was performed 9 months before. On day 1 after this surgery, a relatively mild esotropia was present which developed into a severe esotropia on day 2. Being diagnosed as cyclic esotropia with myopic strabismus fixus, he underwent a 4 mm re-recession of the medial rectus combined with a half-Jensen procedure in his right eye. After the second surgery, the cyclic pattern was no longer present. In patient 2, a 39-year-old female with high myopia had concomitant esotropia for 20 years. At 6 months following bilateral intraocular lens implantation for her high myopia, she demonstrated a cyclic strabismus. On day 1, a 25 prism dioptres esotropia was present, which increased to a 45 prism diopters esotropia on day 2. A 4 mm recession of the medial rectus and 6 mm resection of the LR was performed in her left eye. After surgery, the cyclic pattern disappeared.
Cyclic esotropia can occur in adults with myopic strabismus fixus subjected to horizontal strabismus surgery and with concomitant strabismus following intraocular lens implantation for high myopia. Their cyclic strabismus consisted of a mild squint on day 1 which increased in severity on day 2. The extent of surgery required for correction was based upon the "severe esotropia" experienced on day 2 and resulted in an excellent therapeutic outcome.
目的/背景：周期性内斜视是一种罕见疾病，主要发生于儿童，其特征为眼位正位期与斜视期交替出现，周期规律，为24至96小时。本报告介绍了2例成年周期性内斜视患者，其表现为规律的48小时周期，第一天为轻度偏斜，第二天偏斜加重。
介绍临床报告、临床特征、影像学检查结果及手术效果。
患者1为一名42岁高度近视男性，诊断为进行性内斜视2年。9个月前接受了内直肌和外直肌后徙/缩短术。术后第1天，出现相对轻度的内斜视，术后第2天发展为重度内斜视。诊断为伴有近视性固定性斜视的周期性内斜视后，他接受了右眼内直肌4mm再次后徙联合半詹森手术。第二次手术后，周期性模式消失。患者2为一名39岁高度近视女性，伴有内斜视20年。在其因高度近视行双眼人工晶状体植入术后6个月，出现周期性斜视。第一天，有25棱镜度的内斜视，第二天增加到45棱镜度的内斜视。对其左眼进行了内直肌4mm后徙和外直肌6mm缩短术。术后，周期性模式消失。
周期性内斜视可发生于患有近视性固定性斜视并接受水平斜视手术的成年人，以及因高度近视行人工晶状体植入术后伴有斜视的成年人。他们的周期性斜视表现为第一天轻度斜视，第二天斜视加重。矫正所需的手术范围基于第二天出现的“重度内斜视”，并取得了良好的治疗效果。
