Department of Ophthalmology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
Korean J Ophthalmol. 2023 Apr;37(2):120-127. doi: 10.3341/kjo.2022.0112. Epub 2023 Feb 9.
This study investigated the possibility of neurological etiologies causing acute acquired comitant esotropia (AACE) and to evaluate the differences in clinical features between younger children, older children, and adults.
In this retrospective analysis, patients who had been diagnosed with AACE between July 2017 and June 2021 were included. Data on clinical findings, medical history, brain or orbital imaging, and ophthalmological and orthoptic examinations were retrieved from medical records and analyzed. Patients were divided into three groups based on their age: younger children (<10 years), older children (10-18 years), and adults (>18 years).
Overall, 41 patients with AACE (15 females and 26 males) were examined. Most patients were children. Mild hyperopia was observed in children, while adults had moderate to high myopia. The mean angle of esotropia at a distance fixation was 43.57 ± 9.77, 51.54 ± 8.75, and 30.14 ± 12.39 prism diopters (PD) in younger children, older children, and adult groups, respectively. The mean angle of esotropia at a near fixation was 43.57 ± 9.37, 51.15 ± 9.39, and 31.43 ± 12.15 PD in younger children, older children, and adult groups, respectively. Significant differences were found in the mean angles of esotropia in patients with AACE at both near and far distances according to their age (all p < 0.001). Among 36 patients with previous neuroimaging data, none had AACE secondary to intracranial lesions. Over 2 years, five patients who were under continuous observation did not develop any neurological abnormalities.
AACE was more common in children than in adults. The angle of deviation was larger in children than in adults. Coexisting or underlying neurological diseases were not present in patients with isolated AACE, which eliminated the need for neuroimaging. Continuous follow-up evaluations are warranted when signs of intracranial disease are observed in patients who have not undergone an imaging investigation.
本研究旨在探讨引起急性获得性共同性内斜视（AACE）的神经病因的可能性，并评估不同年龄段（年幼组<10 岁、年长组 10-18 岁、成年组>18 岁）患儿的临床特征差异。
本回顾性分析纳入了 2017 年 7 月至 2021 年 6 月期间被诊断为 AACE 的患者。从病历中提取并分析了临床发现、病史、脑或眶部影像学及眼科和斜视检查等数据。根据年龄将患者分为三组：年幼组（<10 岁）、年长组（10-18 岁）和成年组（>18 岁）。
共有 41 例 AACE 患者（女性 15 例，男性 26 例）接受了检查。大多数患者为儿童。儿童以轻度远视为主，而成人则以中高度近视为主。远距注视时斜视平均角度为年幼组 43.57±9.77 棱镜度（PD）、年长组 51.54±8.75 PD 和成年组 30.14±12.39 PD，近距注视时斜视平均角度分别为年幼组 43.57±9.37 PD、年长组 51.15±9.39 PD 和成年组 31.43±12.15 PD。根据年龄，AACE 患者在远距和近距注视时的斜视平均角度均存在显著差异（均 p<0.001）。在 36 例有既往神经影像学数据的患者中，均未发现颅内病变继发的 AACE。经过 2 年的连续观察，5 例持续观察的患者未出现任何神经异常。
AACE 更常见于儿童而非成人，且儿童的斜视角度大于成人。孤立性 AACE 患者不存在伴发或潜在的神经系统疾病，因此无需神经影像学检查。对于未接受影像学检查的患者，当发现颅内疾病迹象时，需要进行持续的随访评估。
