Clinical presentations of acquired comitant esotropia in 5-35 years old Japanese and digital device usage: a multicenter registry data analysis study.

PURPOSE: To describe clinical presentations of acquired comitant esotropia and digital device use in children, adolescents, and young adults without neurological problems. STUDY DESIGN: Multicenter prospective observational study. METHODS: Patients with acquired comitant esotropia, without intracranial diseases aged 5-35 years at the time of visit, who were seen at pre-registered facilities within 1 year of onset were enrolled. The duration from the onset of symptoms and the time of digital device usage approximately 1 month before onset and their lifestyles were surveyed. Visual acuity, cycloplegic refraction, and strabismus angles were measured. Data were analyzed in three age groups (Child: 5-12 years, Adolescent: 13-18 years, and Young adult: 19-35 years). RESULTS: Between November 2019 and December 2021, 218 patients were enrolled from 55 facilities, and 194 patients (including 62 children, 69 adolescents, and 63 young adults) were analyzed. The child group spent the least amount of time using digital devices (children: 159; adolescents: 210; young adults: 267 min/work day, p < 0.05; (mean time in the same order below) 229, 338, 314 min/holiday, p < 0.05) and had the largest strabismus angle (mean strabismus angle at near: 30, 22, 18 PD, p < 0.01; at far: 28, 26, 21 PD, p<0.05). CONCLUSION: The clinical features of acquired comitant esotropia and hand-held digital device usage differed between children aged ≤ 12 years and older patients. This report gives the current clinical characteristics of young patients with acquired esotropia and digital device usage.

Clinical findings of acute acquired comitant esotropia in young patients.

PURPOSE: This study aimed to identify the characteristics of acute acquired comitant esotropia (AACE) in young patients from a single institution; and clarify their relationship with the excess use of digital devices. STUDY DESIGN: Retrospective, observational. METHODS: We extracted the clinical charts of patients aged between 5 and 35 years who presented at the Hamamatsu University Hospital with AACE symptoms from January 1, 2015 to December 31, 2018. The age of onset, angle of deviation, refractive errors, history of near work, including excess smartphone use, and treatment modality were retrieved. Patients were divided into three groups: CHILD (aged 5-12 years), JUNIOR (aged 13-17 years), and ADULT (aged 18-35 years) and statistically analyzed with Kruskal-Wallis test. RESULTS: Forty-one patients were retrieved, with a mean age at onset of 15.8 (5-28) years; eight in the CHILD group, 23 in the JUNIOR group, and 10 in the ADULT group. Refractive errors and age of patients were correlated, but were not significantly different among groups. The mean angle of deviation at distance was 28.0 ± 12.8 prism diopters (PD) and 28.6 ± 17.2 PD at near. The CHILD group showed the largest near-distant dissociation. History of excessive near work was found in all groups. CONCLUSION: AACE was most commonly found in the JUNIOR group, especially those aged 15-16 years. AACE may encompass multiple diseases; using common diagnostic criteria and asking common questions regarding digital device usage is necessary to clarify the influence of digital device usage, and a multicenter prospective study is recommended.

Two cases of acquired bilateral trochlea nerve palsy treated by simultaneous inferior rectus muscle nasal transposition and inferior oblique muscle myectomy.

PURPOSE: To report two cases of acquired bilateral trochlea nerve palsy with large torsional deviation successfully treated by simultaneous bilateral inferior rectus muscle (IR) nasal transposition and inferior oblique muscle (IO) myectomy. OBSERVATIONS: Case 1 was of a 54-year-old man with torsional diplopia after a traffic accident. He showed 32° and 38° excyclotorsion in the primary and downward gazes, respectively. Case 2 was of a 56-year-old woman with torsional diplopia after a brain tumor operation. She showed 25° and 33° excyclotorsion in the primary and downward gazes, respectively. We simultaneously performed bilateral IR nasal transposition and IO myectomy in these two cases. Postoperatively, case 1 presented with improved excyclotorsion, with 2° and 7° excyclotorsion in the primary and downward gazes, respectively; case 2 similarly presented with improved excyclotorsion, with 4° and 12° excyclotorsion in the primary and downward gazes, respectively. CONCLUSIONS AND IMPORTANCE: Simultaneous bilateral IR nasal transposition and IO myectomy are effective for treating large-angle torsional deviations, especially in downward gaze, requiring only one operation. A new surgical approach is suggested for the successful treatment of large torsional deviations, requiring only one operation.