Clinical Features and Surgical Effectiveness Assessment of Acute Concomitant Esotropia
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目的： 分析101例急性共同性内斜视患者的临床特征、手术方式及治疗效果。 方法： 回顾性系列病例研究。连续纳入2018年11月至2020年11月于武汉爱尔眼科医院就诊的急性共同性内斜视患者101例，其中男71例，女30例，年龄5~76（20.7±11.3）岁。收集患者的临床资料包括患者基本资料、眼部情况以及头颅影像学检查等。采用配对t检验对看近和看远斜视度及手术前后斜视度进行比较。采用χ2检验分析不同年龄段、不同性别的患者屈光状态的差异。 结果： 101例患者中近视81例，远视19例，<12岁组以远视为主，12~30岁组以中高度近视为主，>30岁组以低中度近视为主。发病年龄12~30岁有71例，占比70.3%（71/101）。其中学生有63例，近距离用眼时长大于8 h的占比46.5%（47/101）。裸眼看近斜视度（+42.0±18.3）△，裸眼看远斜视度（+43.7±17.2）△，裸眼看远斜视度大于看近斜视度（t=2.82, P=0.011）；戴镜看近斜视度（+41.6±18.6）△，戴镜看远斜视度（+43.2±17.7）△，戴镜看远斜视度大于看近斜视度（t=2.61, P=0.007）。裸眼与戴镜看远斜视度数大于看近斜视度数患者占总人数24.8%，裸眼与戴镜看近斜视度数大于看远斜视度数患者占总人数7.9%。83例内直肌止端距角膜缘的距离平均为4.74 mm，小于正常值的5.50 mm。最常用的手术方式为内直肌后徙联合外直肌缩短术，所有患者手术均一次成功，术后患者看近看远的斜视度的均数为0△。 结论： 急性共同性内斜视患者多为青少年和20多岁的年轻人，可能与近距离用眼时长过长有关。不同屈光状态患者均有出现急性共同性内斜视的可能。内直肌止端前移解剖异常。急性共同性内斜视患者中裸眼和戴镜看远斜视度数大于看近斜视度数占比高于看近斜视度数大于看远斜视度数。采用内直肌后徙联合外直肌缩短术治疗的患者术后均有良好的手术效果。 Objective: To analyze the clinical features, surgical approach and treatment effect of 101 patients with acute concomitant esotropia. Methods: One hundred and one patients with acute concomitant esotropia admitted to Aier Eye Hospital of Wuhan from November 2018 to November 2020 were included in this retrospective case study, including 71 males and 30 females, ranging in age from 5 to 76 years old, with an average age of (20.7±11.3) years old. Clinical data were collected, including basic patient data, eye condition, and cranial imaging, and paired t test was used to compare the nearsighted and far-sighted strabismus. χ2 test was used to analyze the differences of refractive states in patients of different ages and genders. Results: Among the 101 patients, 81 cases were myopia and 19 cases were hyperopia. The age group under 12 years old mainly had hyperopia, the age group 12 to 30 years old mainly had moderate to high myopia, and the age group above 30 years old mainly had low to moderate myopia. Among them, 71 (70.3%) were aged from 12 to 30 years. Among them, there are 63 students, and 46.5% of them use their eyes at close range for more than 8 hours. There were 81 cases of myopia and 19 cases of hyperopia in all patients. Hyperopia was predominant in the age group below 12 years old, medium and high myopia in the age group from 12 to 30 years old, and low and moderate myopia in the age group above 30 years old. The near strabismus of naked eye (+42.0±18.3)∆ and the far strabismus of naked eye (+43.7±17.2)∆ were higher than that of near strabismus (t=2.82, P=0.011). The degree of nearsighted strabismus with mirror (+41.6±18.6)∆ and the degree of far-sighted strabismus with mirror (+43.2±17.7)∆ were higher than that with mirror (t=2.61, P=0.007). Among all patients when seen with naked eyes and with glasses, the proportion of distal strabismus greater than proximal strabismus is 24.8%, the proportion of proximal strabismus greater than distal strabismus is 7.9%. The average distance from the medial rectus muscle insertion to the corneal limbus in 83 cases was 4.74 mm, which was less than the normal value of 5.50 mm. The most commonly used surgical method in this study was external rectus shortening and internal rectus retromigration. All patients had a successful operation, and the mean strabismus of patients after surgery was 0∆. Conclusions: Most of the patients with acute congenital esotropia are teenagers and young people in their 20 years old, which may be related to the prolonged use of the eyes at close range. Patients with different refractive states may develop acute concomitant esotropia. Acute concomitant esotropia may be accompanied by neurological lesions and anatomic abnormalities such as medical rectus insertion. In patients with acute concomitant esotropia, the proportion of distal strabismus greater than proximal strabismus was higher than proximal strabismus greater than distal strabismus when seen with naked eyes and with glasses. The patients treated with medial rectus recession and lateral rectus resection had good postoperative results.
Objective: To analyze the clinical features, surgical approach and treatment effect of 101 patients with acute concomitant esotropia. Methods: One hundred and one patients with acute concomitant esotropia admitted to Aier Eye Hospital of Wuhan from November 2018 to November 2020 were included in this retrospective case study, including 71 males and 30 females, ranging in age from 5 to 76 years old, with an average age of (20.7±11.3) years old. Clinical data were collected, including basic patient data, eye condition, and cranial imaging, and paired t test was used to compare the nearsighted and far-sighted strabismus. χ2 test was used to analyze the differences of refractive states in patients of different ages and genders. Results: Among the 101 patients, 81 cases were myopia and 19 cases were hyperopia. The age group under 12 years old mainly had hyperopia, the age group 12 to 30 years old mainly had moderate to high myopia, and the age group above 30 years old mainly had low to moderate myopia. Among them, 71 (70.3%) were aged from 12 to 30 years. Among them, there are 63 students, and 46.5% of them use their eyes at close range for more than 8 hours. There were 81 cases of myopia and 19 cases of hyperopia in all patients. Hyperopia was predominant in the age group below 12 years old, medium and high myopia in the age group from 12 to 30 years old, and low and moderate myopia in the age group above 30 years old. The near strabismus of naked eye (+42.0±18.3)∆ and the far strabismus of naked eye (+43.7±17.2)∆ were higher than that of near strabismus (t=2.82, P=0.011). The degree of nearsighted strabismus with mirror (+41.6±18.6)∆ and the degree of far-sighted strabismus with mirror (+43.2±17.7)∆ were higher than that with mirror (t=2.61, P=0.007). Among all patients when seen with naked eyes and with glasses, the proportion of distal strabismus greater than proximal strabismus is 24.8%, the proportion of proximal strabismus greater than distal strabismus is 7.9%. The average distance from the medial rectus muscle insertion to the corneal limbus in 83 cases was 4.74 mm, which was less than the normal value of 5.50 mm. The most commonly used surgical method in this study was external rectus shortening and internal rectus retromigration. All patients had a successful operation, and the mean strabismus of patients after surgery was 0∆. Conclusions: Most of the patients with acute congenital esotropia are teenagers and young people in their 20 years old, which may be related to the prolonged use of the eyes at close range. Patients with different refractive states may develop acute concomitant esotropia. Acute concomitant esotropia may be accompanied by neurological lesions and anatomic abnormalities such as medical rectus insertion. In patients with acute concomitant esotropia, the proportion of distal strabismus greater than proximal strabismus was higher than proximal strabismus greater than distal strabismus when seen with naked eyes and with glasses. The patients treated with medial rectus recession and lateral rectus resection had good postoperative results.
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