Acute Onset Concomitant Esotropia: Sensorial Evaluation, Prism Adaptation Test, and Surgery Planning

Abstract

Background and Objective: Acute acquired concomitant esotropia is a rare form of strabismus that usually presents during infancy or early childhood with diplopia and minimal refractive error. The aim of this study was to evaluate the response to the prism adaptation test in a group of normosensorial patients with acute acquired concomitant esotropia and to determine its predictive value for surgical outcome. Patients and Methods: Six patients (median age, 11.5 years) with acute acquired concomitant esotropia underwent the prism adaptation test by applications of Fresnel press-on and prismatic lenses. The sensorial condition of each patient had been evaluated with the TNO stereopsis test, the Irvine test, Bagolini striated glasses, and the Worth four-dot test during the prism adaptation test, when maximum compensation angle was achieved, and after surgery. In all patients, surgery was performed based on the angle of the squint after the prism adaptation test. Patients were observed 1 day, 3 months, 6 months, and 1 year after surgery. Results: An increase in the angle of the squint occurred in all patients during prism adaptation. The maximum value was obtained in the same amount of time whether with prisms of increasing power or by direct application of the final value of the prisms. The final prismatic value (target angle) was always the same. Conclusions: The accuracy of the patients' selection confirmed the existence of highly reproducible compensational movements to the prismatic correction in not only patients with anomalous retinal correspondence but also normosensorial patients. Prism adaptation test results were useful in these patients because of their high predictive value for the surgical treatment. J Pediatr Ophthalmol Strabismus 2005;42:342–348.

Acute Acquired Concomitant Esotropia

“… 1 – 4 , 6 Some reports describe AACE as being an acute-onset condition confined to children ≥ 5 years of age, which might be one of the primary features that differentiates it from acquired nonaccommodative esotropia. 2 , 14 However, in several other studies it was reported that the acute deviation developed during infancy and early childhood 7 , 8 and diplopia was an inconsistent feature. 4 , 8 Here, we reviewed a large case series of AACE, and, the salient characteristics observed were: (1) concomitant nonaccommodative esotropia with acute onset, (2) an accompanying diplopia or visual confusion, (3) potential for normal binocular vision and highly favorable surgical outcomes for those with deviations >20 PD, (4) ≥ 5 years old at the time of onset, and (5) no tendency for spontaneous resolution.…”

“… 5 AACE is characterized by a sudden onset of concomitant esotropia with diplopia. 1 – 3 , 6 , 7 In 1958, Burian and Miller reported 5 cases of AACE and described the 3 categorical features of AACE, which have been accepted as the fundamental symptoms and the pivotal work in this area. 1 Since then, findings from a number of reports have added to this work.…”

Clinical features of acute acquired comitant esotropia in the Chinese populations

“…AACE is believed to occur during infancy or early childhood, [ 14 ] but some studies found that it can occur in older children and adults. [ 5 , 11 , 14 , 15 ] Accordingly, in the present study, the age at esotropia onset ranged from 3 to 62 years, with a mean age (± SD) of 23.1 ± 11.7 years. Six cases (8.7%) presented at < 10 years, 23 cases (33.3%) presented at 10 to 18 years, and 40 cases (58.0%) presented at >18 years.…”

Treatment of Acute Acquired Concomitant Esotropia

“…The reasons may be related to the prism-eating phenomenon caused by mechanisms that compensate for the deviation. Application of the prism adaptation test (PAT) signi cantly improved the success rate of surgery in AACE patients [6][7][8] However, the PAT itself requires a long time, especially for patients with high strabismus angles. It is di cult for these patients to wear prisms for several days.…”

“…Extraocular muscle surgery remains the main treatment method. However, because of the "eating-prism phenomenon", it is di cult to accurately correct the target deviation [6][7][8][9][10]. Many authors have published satisfactory results in the treatment of various types of strabismus in children, including AACE, with botulinum toxin [1,2,9,[11][12][13][14][15][16][17][18][19].…”