Research progress of pathogenesis and treatment of type Ⅲ acute acquired concomitant esotropia / 眼科新进展

Type Ⅲ acute acquired concomitant esotropia(AACE)often occurs in myopic patients after adolescence.Its exact mechanism is unclear,but it may be related to myopia,convergence-divergence imbalance,overregulation,de-compensation of esotropia,abnormal anatomical structure,and visual center dysfunction.Currently,the main treatment methods include surgery,creotoxin injection,triple prism correction,and visual function training.This article provides a comprehensive review of the pathogenesis and treatment progress of type Ⅲ AACE.

Efficacy comparison of botulinum toxin A injection and extraocular muscle surgery in the treatment of large angle acute acquired concomitant esotropia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the variance in efficacy between botulinum toxin A(BTA)injection and extraocular muscle surgery in managing large-angle(≥+60 PD)acute acquired concomitant esotropia(AACE).METHODS: A retrospective analysis was conducted on clinical data of 60 patients with AACE treated at our hospital from June 2020 to December 2022. Patients were divided into three groups based on different treatments: 2.5 IU BTA injection group(14 cases), 5.0 IU BTA injection group(29 cases), and surgical group(17 cases). Follow-up was conducted for 6 mo after treatment to observe the degree of strabismus after the correction of refractive error, visual function, treatment effectiveness, and occurrence of complications after BTA injection.RESULTS: At 6 mo post-treatment, the degree of strabismus in the surgical group and the 5.0 IU BTA injection group was lower than that in the 2.5 IU BTA injection group(P<0.017). However, there was no significant difference in the degree of strabismus between the surgical group and the 5.0 IU BTA injection group(P>0.017). The effective rate of the 5.0 IU BTA injection group was higher than that of the 2.5 IU BTA injection group(86% vs 43%, P<0.017). There was no difference in visual function among the three groups(P>0.05). The incidence of complications after treatment was not significantly different between the 2.5 IU BTA injection group and the 5.0 IU BTA injection group(43% vs 52%, P>0.05).CONCLUSION: For AACE patients with esotropia degree ≥+60 PD, bilateral medial rectus injection of 5.0 IU BTA can yield outcomes comparable to traditional extraocular muscle surgery, with the advantages of minimal trauma and simple and convenient operation.

Clinical characteristics of acute acquired concomitant esotropia among different age groups / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the clinical characteristics of acute acquired concomitant esotropia(AACE)in patients among different age groups.METHODS: Retrospective analysis of clinical data. A total of 112 non-Swan type AACE patients who underwent surgery at Peking University People's Hospital from January 2015 to December 2022 were retrospectively analyzed. Clinical data were collected and the characteristics were compared, including gender, age, diopter, duration of disease, daily time spent on near work, angles of deviation before and after surgery, stereopsis, etc. According to age, patients were divided into three groups: <18 years old group(22 cases), 18-45 years old group(67 cases), and >45 years old group(23 cases). The clinical characteristics of patients were compared in each group.RESULTS: A total of 112 patients were included in the study, comprising 56 males and 56 females, with a median age of 29.50(19.25, 41.75)years old. Among them, 97 patients had myopia(86.6%). There were 93 patients(83.0%)who spent more than 8 h on near work. The age group <18 years old had the shortest duration before surgery, with a median time of 1.00(0.50, 1.00)a, the minimum negative diopter, with a median diopter of -0.75(-3.19, -0.56)D in the right eye and the diopter of -1.25(-2.81, -0.75)D in the left eye, and the maximum preoperative near angle of deviation, with a median angle of 30.00(18.50, 80.00)PD, and the maximum preoperative distant angle of deviation, with a median angle of 35.00(23.75, 80.00)PD. All these differences were statistically significant compared with other two groups(both P<0.05). For the age group from 18 to 45 years old, the median near angle of deviation was 20.00(14.00, 30.00)PD, and the median distant angle of deviation was 25.00(20.00, 35.00)PD, both of which were higher than those in the age group >45 years old(both P<0.05). For the age group >45 years old, the median near angle of deviation after surgery was -4.50(-7.50, 0)PD, and the median distant angle of deviation after surgery was 4.50(0, 9.50)PD, which were smaller than those in other two groups(all P<0.05). The age group >45 years old had the hiughest surgical success rate(100%). The preoperative stereopsis was better in age group >45 years old than the group <18 years old(P<0.05). The postoperative stereopsis of the age group of 18 to 45 years old and the age group >45 years old was better than age group <18 years old(both P<0.05).CONCLUSION: Surgical patients with AACE are mainly in the age group from 18 to 45 years old. The characteristic of angle of deviation is that distant angle of deviation is greater than near angle of deviation. The patients <18 years old have larger preoperative angles of deviation than adults, while their stereoacuity is worse than adults in the early postoperative period. It is recommended that augmented-dose surgery should be performed in AACE patients who are in the age group of 18 to 45 years old(5-10 PD). A conservative surgery should be designed for hyperopia young children without established binocular vision.

Case report on heavy eye syndrome

In high myopia, acquired esotropia can be present as strabismus fixus convergence also known as Heavy Eye Syndrome (HES). Although exotropia and hypertropia have been reported, patients typically present with diplopia due to increasing esotropia and hypotropia with limitations on abduction and elevation. We reported two cases of HES based on history and clinical examination, which includes anterior and posterior segment examination and squint evaluation. The MRI of both patients showed displacement of lateral rectus inferiorly and nasal shifting of superior rectus. In both the cases forced duction test (FDT) was positive for affected medial rectus (MR) when performed under local anaesthesia. Subsequently, they underwent loop myopexy of superior rectus (SR) with medical rectus (MR) along with MR recession for affected eye. Postoperatively, Case 1 had a residual esotropia of 18 prism dioptre (PD) and case 2 had 40 PD compare to preoperatively 70 and 80 PD respectively, measured with the krimsky test. Axial length lengthening and herniation of sclera between the SR and LR muscles are the two main contributors to HES. To stop additional herniation, the inter-muscular link must be restored. Loop myopexy is an elegant and effective procedure to achieve good cosmetic and functional results for HES.

Occurrence and subsequent development of vertical deviations in patients treated surgically for infantile esotropia

Purpose: The purpose of this study was to evaluate the onset of dissociated vertical deviation (DVD) and inferior oblique overaction (IOOA), their subsequent development, and their correlation with pre and postoperative parameters. Methods: Medical records of patients with infantile esotropia who underwent surgery between 2005 and 2017 were retrospectively reviewed. DVD and IOOA were measured before and after surgery. Patients were divided into two groups based on horizontal and vertical deviation at the time of presentation: those with infantile esotropia only (group A) and patients with infantile esotropia who developed vertical deviation (group B). Results: Out of a total of 102 patients, DVD occurrence was seen in 53 patients (51.9%) and IOOA was seen in 50 patients (48.04%). DVD was seen in 22 patients at the time of initial examination and in 31 patients postoperatively. IOOA at presentation was seen in 45 patients (44.1%) and 5 patients (8.8%) postoperatively. No statistical difference was found in the age of surgery, angle of deviation, mean follow?up, and mean refractive error within both groups. The postoperative motor outcome was statistically comparable between the two groups (P = 0.29). Sensory outcomes of fusion (P = 0.048) and stereopsis (P?value = 0.00063) were better in group A. Conclusion: No correlation was found between the age of occurrence and development of vertical deviation with refractive error, angle of deviation, age, or type of surgery. We found that motor outcomes are not affected but sensory outcomes are affected in patients with vertical deviations. This indicates that DVD and IOOA are developed due to inherent disruption of fusion and stereopsis

Retrospective analysis of strabismus surgery in adolescents and children in Yunnan province / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the strabismus surgery situation of adolescents and children in Yunnan province.METHODS: A retrospective analysis was conducted on medical records data of 3 068 adolescents and children who received strabismus surgery at Affiliated Hospital of Yunnan University from January 2017 to December 2021. The analysis included gender, constituent ratio of age, distribution of strabismus types and combination with other ocular diseases, etc.RESULTS: Among the included patients, 52.12% were males, and 47.88% were females. Preschool patients(1 to 6 years old)accounted for 32.89%, primary pupils(7 to 12 years old)accounted for 45.89% and high school students(13 to 18 years old)accounted for 21.22%. Exotropia accounted for 63.17% of the total strabismus, of which intermittent exotropia was the most common type. Esotropia accounted for 19.69%, and concomitant esotropia was the most common type. The special type of strabismus accounted for 17.14%, and A-V syndrome and dissociative vertical deviation(DVD)were the most common types. Strabismus combined with ametropia accounted for 61.02% and amblyopia accounted for 10.89%. A few patients also combined with other eye diseases.CONCLUSION: In Yunnan province, intermittent exotropia was the most common type of strabismus among adolescents and children. Some patients combined with other ocular diseases.

Efficacy comparison of Jensen and augmented Hummelsheim procedure in the treatment of complete paralytic esotropia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficacy of Jensen and augmented Hummelsheim procedures in the treatment of complete paralytic esotropia.METHOD: A total of 35 patients(44 eyes)who were diagnosed with complete paralytic esotropia from October 2016 to October 2020 were retrospectively analyzed, of which 15 cases(21 eyes)underwent Jensen procedure combined with recession of antagonist muscle(Jensen procedure group), and 20 cases(23 eyes)received augmented Hummelsheim procedure combined with recession of antagonist muscle(Hummelsheim procedure group). The operation time, preoperative and postoperative esotropia deviation, degree of abduction paralysis, recession of medial rectus muscle and cure rate were observed.RESULTS: Clinical data and operation time of the patients in two groups were not statistically significant(P >0.05). During the last follow-up, the esotropia deviation of Jensen procedure group decreased from 102.33±41.70PD to 3.93±4.82PD(P<0.001), and it decreased from 94.75±33.03PD to 2.85±5.96PD in Hummelsheim procedure group(P<0.001), while the degree of abduction paralysis were significantly improved from -4.81±0.40 to -1.57±0.51 in the Jensen procedure group(P<0.001)and from -4.91±0.29 to -1.22±0.42 in Hummelsheim procedure group(P<0.001). Besides, there was no statistical difference in postoperative esotropia deviation between the two groups(P>0.05), but the degree of postoperative abduction paralysis in the Hummelsheim procedure group was significantly better than that of Jensen procedure group(P<0.05). The recession of medial rectus muscle of the two groups were 7.16±2.07 and 6.37±2.34 mm, respectively(P>0.05). During the last follow-up, in the Jensen procedure group, 2 patients were undercorrection(+10PD and +12PD respectively)and 13 cases(87%)were cured. In the Hummelsheim procedure group, 1 patient was undercorrection(+25PD)and 19 patients were cured(95%), and there was no statistical significance in cure rates of the two groups(P=0.565).CONCLUSIONS: Both Jensen procedure and augmented Hummelsheim procedure can effectively treat complete paralytic esotropia, and the latter is more effective in improving the abduction paralysis.

Spontaneous consecutive exotropia after conservative management of accommodative esotropia

@#Spontaneous consecutive exotropia (SCXT) in conservatively managed accommodative esotropia is not widely discussed. The author presents a case series of 4 patients with SCXT describing patient characteristics and possible risk factors. Management modifications based on this series are proposed. Four cases of patients who initially presented with accommodative esotropia and later developed SCXT are presented. The age range at presentation was between 4 months to 3 years, with total follow-up ranging between 8–15 years. All four cases presented with esotropia on or before the age of 3 years, with initial hyperopia ranging between +1.50 to +4.25. The SCXT occurred between ages 2–7 years. Possible risk factors identified include amblyopia, dissociated vertical deviation, rapid control of esodeviation, inferior oblique overaction, and poor follow-up during the course of their strabismus. The author recommends earlier tapering of hyperopia correction following initial control with full cycloplegic refraction. Identified risk factors should alert the specialists to be wary of SCXT.

Clinical characteristics and treatment of patients with acute acquired concomitant esotropia in different refractive status / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the clinical characteristics and treatment of patients with acute acquired concomitant esotropia(AACE)in different refractive status.METHODS: A retrospective analysis was conducted on 110 patients with non-type I AACE treated from January 2020 to January 2022. The non-myopic group(30 cases, spherical equivalent>-0.5D)and the myopic group(80 cases, spherical equivalent≤-0.5D)were divided according to the refractive status. The degree of deviation, accommodative convergence and accommodation ratio(AC/A), visual function, and surgical methods were observed. RESULTS: The non-myopic group had no difference in the degree of near deviation [(47.13±23.54)△] and the degree of distant deviation [(48.90±22.59)△](P>0.05); near deviation [(40.49±26.09)△] of myopic group was less than distant deviation [(50.09±25.41)△](P<0.001); and there was no difference in the same distance between the two groups(P>0.05). AC/A in the non-myopic group(5.40±2.23)was higher than that in the myopic group(3.14±3.10; P<0.05). Patients in the myopic group had better near stereopsis than the non-myopic group(P<0.05). The non-myopic group had a variety of surgical methods, while the myopic group mostly used lateral rectus resection or/and medial rectus recession.CONCLUSION: AACE can occur in different refractive status. Non-myopic patients have the same degree of distant and near strabismus, high AC/A, and varied surgical methods. However, myopic patients have less degree of near deviation than distant deviation and have normal AC/A and better near stereopsis, and lateral rectus resection or/and medial rectus recession are commonly used.

Esotropia, nystagmus and optic disk staphyloma in Donnai-Barrow syndrome / Esotropia, nistagmo e estafiloma de disco óptico na síndrome de Donnai-Barrow

ABSTRACT A 12-year-old boy with Donnai-Barrow syndrome diagnosed intra-uterus presented esotropia, high myopia, nystagmus, and optic disk staphyloma in an ophthalmologic examination. The patient had associated Fanconi syndrome and sensorineural hearing loss as well as facial manifestations as hypertelorism, downward slanting of palpebral fissures and low ear implantation. Magnetic resonance imaging revealed agenesis of the corpus callosum. To our knowledge, this is the first reported case associated with esotropia, nystagmus, and optic disk staphyloma.

RESUMO Paciente do sexo masculino, 12 anos, com diagnóstico intrauterino de síndrome de Donnai-Barrow, apresentava ao exame oftalmológico esotropia, alta miopia, nistagmo e estafiloma de disco óptico. Associado ao quadro, apresentava síndrome de Falconi e perda auditiva neurossensorial, além de alterações faciais, como hipertelorismo, inclinação inferior das fissuras palpebrais e implantação baixa das orelhas. Ressonância magnética revelou agenesia de corpo caloso. Ao nosso conhecimento, este é o primeiro caso relatado associando esotropia, nistagmo e estafiloma de disco óptico.

PREVALENCE OF STRABISMUS IN CHILDREN ATTENDING A TERTIARY CARE HOSPITAL IN KASHMIR

Background: Strabismus is an ocular condition wherein the visual axis of two eyes do not meet at an object of regard, with esotropia being the most common pattern of strabismus. To ?nd the Aim: prevalence of strabismus in children between 5-20 years of age attending the OPD of Department of Ophthalmology, Government Medical College, Srinagar. This was a cross-sectional study wherein 3000 patients between the age Methods: group of 5-20 years attending the OPD of a tertiary care centre from august 2019 to august 2021 were taken into consideration. Proper birth history and family history was taken from these patients. Proper ophthalmological examination was done which included uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA). Ocular misalignment was diagnosed by cover uncover test and angle of deviation was measured by prism bar test. Out of 3000 patients, only 60 patients were found Results: to have strabismus with overall prevalence of strabismus in our study being 2%. In our study, 66.7% cases were girls and 33.3% cases were boys. Esotropia was most prevalent form of strabismus accounting for 60% of cases followed by exotropia accounting for 40% cases Our study indicated the prevalence of strabismus as 2%. Proper screening, early Conclusion: detection and adequate management of ocular misalignment can help in reducing the burden of strabismus in the population

Independent risk factors of type III acute acquired concomitant esotropia: A matched case–control study

Purpose: To investigate the risk factors and surgical design for type III acute acquired concomitant esotropia (AACE). Methods: In this retrospective, matched, case–control study, 51 patients developed type III AACE between March 2018 and September 2020, and the control group consisted of 60 patients matched by age and refractive power during the same period. A history of the duration of near work per day and the use of glasses were reviewed, and the refractive power of both eyes, deviation angles at both near and far vision, visual function, and treatment options were analyzed. Additionally, the distance from medial rectus insertion to the limbus was measured in surgical patients. The data were analyzed by logistic regression analysis. Results: We found that 99.96% of the patients and 91.67% of the controls had myopia. Of these, 60.8% and 20.0%, respectively, did not wear glasses for near work. Twelve patients were treated with a prism and 39 were treated surgically. The average time devoted to near work per day was 7.24 and 3.7 h by the patients and controls, respectively. Univariate logistic regression analysis showed that increased hours of near work per day and near work without the use of spectacles were associated with the incidence of type III AACE. Multiple logistic regression analysis revealed that increased hours of near work per day and near work without the use of glasses were independent risk factors for AACE. Conclusion: Increased hours of near work per day and uncorrected myopia in near work are independent risk factors for type III AACE

Results of fusional vergence therapy in managing consecutive esotropia: A case series

Purpose: To analyze the efficacy of fusional vergence therapy (FVT) in management of consecutive esotropia with diplopia after intermittent exotropia (IXT) surgery. The current study is carried on how FVT affects the duration of treatment, sensory fusion, and exotropic drift. Methods: This was a retrospective study for the medical record of 11 patients with consecutive esotropia after IXT surgery of 543 patients over the period of 5 year, with mean surgery age of 9.5 (range: 4–33 y). FVT was planned after minimum 6 weeks of surgery and was considered for maximum 24 weeks. Patients underwent a combination of office-based and home-based FVT. Successful outcome of therapy was considered where diplopia resolves in free space and achieves sensory fusion, stereopsis with no manifest deviation. Results: Record of 543 patients who had horizontal muscle surgery for IXT were identified and reviewed. Records of 11 patients who showed consecutive esotropia of 10 prism diopter (PD) or more with normal retinal correspondence, with or without diplopia complaint, after 6 week of surgery and had undergone vision therapy management were reviewed. A successful outcome of binocular single vision with good sensory and motor fusion with no manifest deviation or prism requirement was achieved with in the mean duration of 4.8 month of therapy. With a mean duration of 4 weeks of therapy, the mean angle of deviation reduced by 53% for distance (17 PD to 8 PD) and 27% for near (11 PD to 8 PD) and mean stereopsis improvement by 80% with 94% patients demonstrating sensory fusion on Bagolini test and 94% of patients having no symptoms of diplopia or squint. Conclusion: With nonsurgical management involving refractive error correction, FVT, and prism, consecutive esotropia was resolved in 74% cases. Management of consecutive esotropia with FVT can result in satisfactory sensory fusion and successful motor alignment.

Clinical characteristics of acute acquired comitant esotropia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To describe the clinical characteristics of 20 patients with acute acquired comitant esotropia(AACE). <p>METHODS: This retrospective, observational case series study enrolled patients with AACE examined from June 2018 to May 2021 in Guangdong Jiangmen Central Hospital. The age when attacked, the duration of excessive near work before illness, symptom, refraction, AC/A, deviation and near stereopsis were analyzed. All 20 patients had unremarkable neurological finding by imageological test. <p>RESULTS: Most patients whose mean age was 24.25±5.78 years immersed in near work for more than 6h a day before illness. All patients seeked for medical help because diplopia with normal ocular motility in all directions of gaze and meaningless finding in routine ophthalmologic examinations. They were all nearsightedness whose mean spherical equivalent was -5.73±5.09D, while mean AC/A was 2.65±1.16 within the upper limit. There was no different between the distant and near deviations(<i>P</i>>0.05). Deviations might be correlated with near stereopsis(<i>P</i><0.05), however the duration from onset to treatment was irrelevant(<i>P</i>>0.05).<p>CONCLUSION: The clinical features of AACE in older children and adults who immersed excessive near work are medium myopia, diplopia, normal ocular motility, no neurological finding and limited AC/A. Moreover, it is approximate between distant and near deviations. The deviations affect near stereopsisd more, while the influence of duration from onset to treatment may be less.

Is hypermetropia regressing in accommodative esotropia? / A hipermetropia regride na esotropia acomodativa?

ABSTRACT Purposes: To evaluate the relationship of changes in hypermetropia and ocular alignment in patients with accommodative esotropia. Methods: The medical records of consecutive patients diagnosed with refractive accommodative esotropia (esotropia eliminated or decreased to within 10 D with full hyperopic correction) were retrospectively reviewed. Cycloplegic refractions culled from medical records were converted into spherical equivalents. Presence of amblyopia, changes in refractive error and ocular alignment at admission and after the follow-up period were evaluated. Results: Seventy patients (mean age: 6.01 ± 5.41 years; female: 60.6%; mean follow-up: 5.8 ± 3 years) had corrected esotropia of 40 ± 20 prismatic diopters at admission. The average decrease per year in near and distance deviations with glasses was 1.71 ± 3.96 prismatic diopters/year and 1.09 ± 3.25 prismatic diopters/year, respectively. The total myopic shift of the right and left eyes was 1.08 ± 1.35 D and 1.20 ± 1.40 D, respectively. Myopic shift/year was 0.22 D/year and 0.26 D/year, respectively. The correlation between the rate of myopic shift and rate of change in corrected near deviation was weak. The correlation for the rate of myopic shift was not high for the right and left eyes (r=0.18; p=0.15). Conclusion: The amount of deviation and hypermetropia gradually decreased in accommodative esotropia during follow-up. On the other hand, it may be incorrect to assure patients that the amount of deviation will decrease in parallel with the refractive error.(AU)

RESUMO Objetivo: Avaliar a relação entre alterações na hipermetropia e o alinhamento ocular em pacientes com esotropia acomodativa. Métodos: Foram analisados retrospectivamente prontuários médicos de pacientes consecutivos diagnosticados com esotropia acomodativa refrativa (com esotropia eliminada ou reduzida a menos de 10 D com correção completa da hipermetropia). As medidas de refração em cicloplegia obtidas dos prontuários foram convertidas em equivalentes esféricos. Avaliaram-se ainda a presença de ambliopia, alterações do erro refrativo e o alinhamento ocular à admissão e depois do período de acompanhamento. Resultados: Setenta pacientes (média de idade=6,01 ± 5,41 anos, 60,6% do sexo feminino, acompanhamento médio de 5,8 ± 3 anos) apresentaram esotropia de 40 ± 20 dioptrias prismáticas (DP) para perto à admissão. A diminuição média anual no desvio para perto e para longe com o uso de óculos foi de 1,71 ± 3,96 DP/ano e 1,09 ± 3,25 DP/ano, respectivamente. Os desvios miópicos totais dos olhos direito e esquerdo foram de 1,08 ± 1,35 D e 1,20 ± 1,40 D, respectivamente. Os desvios miópicos anuais foram de 0,22 D/ano e 0,26 D/ano para os olhos direito e esquerdo, respectivamente. A correlação entre a taxa de desvio miópico e a taxa de alteração do desvio para perto corrigido foi fraca. A correlação da taxa de desvio miópico não foi alta para os olhos direito e esquerdo (r=0,18, p=0,15). Conclusão: A quantidade de desvio e a hipermetropia diminuem gradualmente na esotropia acomodativa durante o acompanhamento. Por outro lado, pode não ser apropriado garantir aos pacientes que o desvio diminuirá em paralelo ao erro refrativo.(AU)

Convergence excess consecutive esotropia associated with 0.01% atropine eye drops usage in patients operated for intermittent exotropia

To report convergence excess esotropia (CEET) following 0.01% atropine eye drops (Low dose atropine [LDA]). Children who developed CEET that resolved promptly after discontinuation of LDA are described. Three myopes aged 5.3 � 1.2 years and mean sphere -4.5D were included. All were operated for intermittent exotropia earlier. Mean esotropia was +28.3PD for near and 10.6PD for distance. LDA induced high AC/A ratio and fusion normalized in 3 weeks after discontinuation of LDA. LDA should be used with caution in patients with esophoria or previously operated for intermittent exotropia. Any evidence of the emergence of a CEET should warrant discontinuation of LDA.

Infantile esotropia in Malaysian children: The impact of surgery on health-related quality of life assessment in patients and their parents

@#Introduction: Limited information is available on healthrelated quality of life (HRQoL) in children with strabismus in South East Asia. We aimed to evaluate the HRQoL and associated factors pre- and post-strabismus surgery in Malaysian children with infantile esotropia and their parents/guardians. Methods: A prospective study was conducted on children with infantile esotropia aged 8-17 years old and their parents/guardians who attended two tertiary hospitals with a paediatric ophthalmology service from 2017 to 2018. The patients and parents answered the Intermittent Exotropia Questionnaire (IXTQ), translated into Malay, at the time of enrolment and three months after the surgery. Results: Thirty-four children and one (each) of their parents/guardians were enrolled. Thirteen (38.2%) children had esotropia with angles of deviation of more than 50 prism dioptres. A total of 33 (97.1%) children achieved successful alignment correction three months after surgery. Surgery significantly improved the total mean scores of the children, which were 62.87 (17.05) preoperatively and 87.13 (13.26) postoperatively (p<0.001). There was statistically improvement in the total mean scores in the parent/guardian group, which was 37.07 (22.01) preoperatively and 75.39 (22.09) postoperatively (p<0.001). The parents/guardians functional, psychosocial and surgery subscales also had a significant increment in the score postoperatively (p<0.001). Older children and children with poorer visual acuity on presentation had a lower score preoperatively, while girls scored better postoperatively (p<0.05). Mothers scored significantly lower preoperatively and postoperatively (p<0.05). Conclusion: Surgery significantly improved the HRQoL score in Malaysian children with infantile esotropia and their parents/guardians. The score was significantly higher in female children after the surgery. Mothers exhibited poor scores before and after surgery

Research progress on the risk factors and treatment of consecutive esotropia after exotropia surgeries / 上海交通大学学报（医学版）

Consecutive strabismus refers to the secondary manifest strabismus right after or a period after strabismus surgeries, including consecutive esotropia and consecutive exotropia. It is reported that the incidence of consecutive esotropia is 6%-20%. Consecutive esotropia may lead to increased risks of amblyopia and visual deficiency in children and diplopia in adults. As the multiformity and complexity of continuous esotropia, there exist many challenges for clinicians to know the risk factors well and select appropriate treatment. The article reviews the latest research progress on the risk factors and treatment strategies of consecutive esotropia, aiming to help better evaluate the risks of continuous esotropia after exotropia surgeries, adjust the operation plans, and provide references to select the appropriate treatment plan.

Effect analysis of partial transposition of vertical rectus combined with medial rectus recession under microscope on treatment of complete abducens nerve palsy esotropia / 上海交通大学学报（医学版）

Objective: To investigate the clinical effect of partial transposition of the vertical rectus combined with medial rectus recession on the treatment of abducens nerve palsy esotropia under the microscope. Methods: Nine patients with abducens nerve palsy esotropia were treated in Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine from March 2015 to June 2017. The strabismus surgery was performed under the microscope, with partial transposition of the vertical rectus combined with medial rectus recession. Postoperative follow-up was performed to observe the effect. Results: After 1 week, 7 patients’ primary position were orthotopic(within ±10Δ), and 2 patients were undercorrection (+15Δ and +20Δ). Abduction function of all the patients improved significantly. The eyes could cross the midline. After 1 month, 6 patients’ primary position were orthotopic (within ±10Δ), 3 patients were undercorrection(respectively +15Δ, +15Δ and + 30Δ). After 1 year, 5 patients’ primary position were almost orthotropia (within ±10Δ), and 4 patients were undercorrection (respectively +15Δ, +15Δ, +30Δ and +40Δ). Conclusion: Partial transposition of the vertical rectus combined with medial rectus recession under the microscope is a safe and effective surgical method in treatment of complete abducens nerve palsy esotropia. It can not only improve the ocular position, but also effectively improve the abduction function of the paralytic eye. However, it is easy to be undercorrection in the long-term.