Interventions for infantile esotropia.
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ABSTRACT:
SUBMITTER: Mehner L
PROVIDER: S-EPMC9841886 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
Publications
Interventions for infantile esotropia.
Mehner Lauren L Ng Sueko M SM Singh Jasleen J
The Cochrane database of systematic reviews 20230116
<h4>Background</h4>Infantile esotropia (IE) is the inward deviation of the eye. Various aspects of the clinical management of IE are unclear; mainly, the most effective type of intervention and the age at intervention.<h4>Objectives</h4>To examine the effectiveness and optimal timing of surgical and non-surgical treatment options for IE to improve ocular alignment and achieve or allow the development of binocular single vision.<h4>Search methods</h4>We searched CENTRAL, MEDLINE, Embase, one othe ...[more]
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Project description:PurposeTo investigate the characteristics of horizontal rectus muscle insertion sites in patients with infantile esotropia (IE) and acute acquired concomitant esotropia (AACE).MethodsThe medical records of 166 IE patients and 261 AACE patients who underwent horizontal rectus muscle surgeries were reviewed retrospectively, including age at surgery, spherical equivalent (SE), and angle of esodeviation at near and distance. The limbus-insertion distances (LID) and widths of the medial rectus (MR) and lateral rectus (LR) muscles were measured intraoperatively using a caliper. The insertion parameters and clinical features were compared between different ages and types of esotropia, and a correlation analysis was performed between these variables.ResultsIn IE patients under 12 years old, the MR LID was positively correlated with age, whereas the LR LID was negatively correlated with the angle of esodeviation at distance. In IE patients over 12 years old, the LR width was negatively correlated with the angle of esodeviation at near. In AACE patients, the MR LID was negatively correlated with the angle of esodeviation at distance, whereas the LR width was negatively correlated with the SE.ConclusionsThe LID and width of the horizontal rectus muscle insertions were not significantly different in age-matched patients with IE and AACE. In IE patients, the LR insertion parameters were correlated with the angle of esodeviation, but in AACE patients, the MR LID was correlated with the angle of esodeviation. The clinical significance of these findings still needs to be investigated further.
| S-EPMC11786817 | biostudies-literature
Project description:PurposeInfantile esotropia is associated with abnormal visual development and thus may delay the achievement of developmental milestones. Although early surgery can improve visual function, less is known about its effect on motor development. Here we address whether early surgery can improve motor development.MethodsRecently, our lab devised the Infant Developmental Skills Survey, a 25-item questionnaire designed to assess sensorimotor and gross motor development. The questionnaire was completed by the parents of 3- to 10-month-old patients with infantile esotropia prior to surgery (n = 143) and the parents of 6- to 11-month-old patients following surgery (n = 58). A subset of parents (n = 40) completed the questionnaire both before and after surgery. For comparison, the questionnaire was completed by the parents of infants with normal ocular alignment (n = 194).ResultsBefore surgery 4-, 5-, 6-, 7-, 9-, and 10-month-old patients showed delayed achievement of sensorimotor milestones (p < 0.01), and 5-, 9-, and 10-month-old patients demonstrated delayed attainment of gross motor milestones (p < 0.05) compared with normal children. However, following surgery, patients demonstrated a greater rate of sensorimotor development than age-matched controls (p < 0.0001) and caught up with normal children on both sensorimotor and gross motor skills.ConclusionsPrior to surgery, patients with infantile esotropia were delayed in their achievement of developmental milestones. However, following surgery, a comparison group of patients showed rapid development and possessed motor skills comparable to those of normal children, suggesting that early surgery is beneficial to both visual and motor development.
| S-EPMC2476213 | biostudies-literature
Project description:Abnormal brain structural and functional properties were demonstrated in patients with infantile esotropia (IE). However, few studies have investigated the interaction between structural and functional connectivity (SC-FC) in patients with IE. Structural network was generated with diffusion tensor imaging and functional network was constructed with resting-state functional magnetic resonance imaging for 18 patients with IE as well as 20 age- and gender- matched healthy subjects. The SC-FC coupling for global connectome, short connectome and long connectome were examined in IE patients and compared with those of healthy subjects. A linear mixed effects model was employed to examine the group-age interaction in terms of the coupling metrics. The Pearson correlation between coupling measures and strabismus degree was evaluated in IE patients, on which the regulatory effect of age was also investigated through hierarchical regression analysis. Significantly decreased SC-FC coupling score for short connections was observed in left caudate nucleus (CAU) in IE patients, whereas no brain regions exhibited altered coupling metrics for global connections or long connections. The group-age interaction was also evident in local coupling metrics of left CAU. The age-related regulatory effect on coupling-degree association was distinguishing between brain regions implicated in visual processing and cognition-related brain areas in IE patients. Local SC-FC decoupling in CAU was evident in patients with IE and was initiated in their early postnatal period, possibly interfering the visual cortico-striatal loop and subcortical optokinetic pathway subserving visual processing and nasalward optokinesis during neurodevelopment, which provides new insight into underlying neuropathological mechanism of IE.
| S-EPMC9815444 | biostudies-literature
Project description:PurposeTo describe phenotyping and linkage analysis results for available members from a consanguineous nuclear family with hereditary congenital strabismus.MethodsBoth parents and all 12 children underwent clinical examination. Available affected and several unaffected family members had venous blood sampling for DNA extraction and 10K single nucleotide polymorphism (SNP) genotyping (Affymetrix Gene Chip® Human). Multipoint logarithm of the odds (LOD) score calculations were performed assuming an autosomal recessive mode of inheritance with 100% penetrance and disease allele frequency of 0.01%.ResultsThree children had non-syndromic large-angle infantile esotropia without significant hyperopia. A fourth child had left esotropic Duane retraction syndrome. A fifth child who had esotropia in the setting of prematurity and childhood poliomyelitis was excluded from the analysis. A sixth child had keratoconus and was excluded. Both parents and the remaining 6 children had no significant orthoptic or ophthalmic findings. Using linkage analysis including the 4 esotropic children, disease loci were mapped to regions on chromosomes 3p26.3-26.2 and 6q24.2-25.1 using multipoint linkage analysis with LOD scores of 3.18 and 3.25 respectively. Linkage to these regions persisted when the esotropic Duane retraction syndrome patient was excluded from the linkage analysis (LOD scores of 2.00 and 2.32, respectively).ConclusionsNon-syndromic infantile esotropia could be related to susceptibility loci on chromosomal regions 3p26.3-26.2 and 6q24.2-25.1 and may share alleles that underlie Duane retraction syndrome.
| S-EPMC3154136 | biostudies-literature
Project description:Previous studies have shown that functional networks are present at birth and change dynamically throughout infancy and early childhood. However, the status of functional connectivity is still poorly understood in patients with infantile esotropia (IE). The aim of this study is to investigate the developmental trends of functional connectivity in patients with IE during a critical period of growth and development. A total of 17 patients with IE (9 males and 8 females; mean age: 3.36 ± 2.03 years, age range: 0.67-6.36 years) and 20 healthy subjects matched for age and gender were recruited and underwent resting-state functional magnetic resonance imaging. The whole-brain functional network connectivity was analyzed for the IE group and healthy control group. A general linear model was applied to assess the group-age interaction in terms of the functional connectivity. The discrepancy between the two groups in functional connectivity trajectories was also quantified across age and exhibited by the quadratic parabolic model. There were significant group-age interactions between the visual network and the default mode network, the visual network and the sensorimotor network, the limbic network and the default mode network, and within the limbic network in the functional connectivity. A U-shaped tendency across age, with an "inflection point" ranging from 3.1 to 4.0 years of age was exhibited in the difference between functional connectivity trajectories of the IE patients and normal controls. Abnormality in functional network connectivity could present in IE patients at birth, exhibiting aberrant developmental patterns over time. An abnormal functional network could reduce the ability of the cortex in visual information processing, further reactivating the subcortical visual information processing system, which is probably the pathogenesis of IE. Three to four years after birth is the critical time window for children with IE to establish normal network connections in the brain. Early surgery during this period may be helpful for affected children to have an opportunity to approach the normal development trajectory as early as possible.
| S-EPMC9433796 | biostudies-literature
Project description:BackgroundGrowing evidences have indicated neurodevelopmental disorders in infantile esotropia (IE). However, few studies have analyzed the characteristics of large-scale functional networks of IE patients or their postoperative network-level alterations.MethodsHere, individuals with IE (n = 32) and healthy subjects (n = 30) accomplished the baseline clinical examinations and resting-state MRI scans. A total of 17 IE patients also underwent corrective surgeries and completed the longitudinal clinical assessments and resting-state MRI scans. Linear mixed effects models were applied for cross-sectional and longitudinal network-level analyses. Correlation analysis was performed to assess the relationship between longitudinal functional connectivity (FC) alterations and baseline clinical variables.ResultsIn cross-sectional analyses, network-level FC were apparently aberrant in IE patients compared to controls. In longitudinal analyses, intra- and internetwork connectivity were observed with significant alterations in postoperative IE patients compared to the preoperative counterparts. Longitudinal FC changes are negatively correlated to the age at surgery in IE.ConclusionsObviously, altered network-level FC benefiting from the corrective surgery serves as the neurobiological substrate of the observed improvement of stereovision, visuomotor coordination, and emotional management in postoperative IE patients. Corrective surgery should be performed as early as possible to obtain more benefits for IE in brain function recovery.
| S-EPMC10454265 | biostudies-literature
Project description: Not available
| S-EPMC6513200 | biostudies-literature
Project description:PURPOSE: To validate a table of amounts of three horizontal muscle surgery in patients with large-angle infantile esotropia (≥60 prism dioptres, PD). METHODS: A prospective interventional case series reporting the postoperative alignment of 51 patients (27 male, 24 female) over a 15-year period was conducted. Surgery amounts were according to a published table developed on a previous patient cohort (n=49), using bilateral medial rectus recession with graded unilateral lateral rectus resection. Kaplan-Meier life-table survival curves were formulated for success to orthotropia (±10 PD) after one and subsequent horizontal muscle surgeries for up to 8 years follow-up. RESULTS: The median preoperative deviation was 65 PD (range 60-80 PD) and median age at surgery was 11.8 months (range 5.1 months-3.6 years). Surgical success to orthotropia (±10 PD) after one surgery was 100% at 2 months, 95.7% at 6 months, 91.3% at 12 months, 77.8% at 4 years, and 73.6% at 8 years. Postoperative failure requiring further horizontal surgery occurred in 17.6% (residual esotropia 4, consecutive exotropia 5). CONCLUSIONS: Our second cohort has reproduced the success rate of the previous cohort (77.8% vs 77.1% at 4 years). If the published table of surgical amounts is used, three horizontal muscle surgery in large-angle infantile esotropia (≥60 PD) appears to have a good long-term success rate, and does not lead to the high rates of either residual esotropia or consecutive exotropia reported by others in the literature.
| S-EPMC3213649 | biostudies-other
Project description:Background/objectivesA national study was undertaken through the British ophthalmology surveillance unit (BOSU) to determine the incidence, presenting features and management of essential infantile esotropia (EIE) in the UK.MethodsData from a prospective national observational study of newly diagnosed EIE presenting to clinicians in the United Kingdom over a 12-month period were collected. Cases with a confirmed diagnosis by a clinician of a constant, non-accommodative esotropia ≥20 prism dioptres (PD), presenting at ≤12 months, with no neurological or ocular abnormalities were identified through BOSU. Follow-up data were collected at 12 months.ResultsA total of 57 cases were reported giving an incidence of EIE of 1 in 12,828 live births. The mean age of diagnosis and intervention were 7.05 ± 2.6 months (range 2-12) and 14.7 ± 4.9 months (range 6.5-28.1), respectively. Management was surgical in 59.6%, botulinum toxin alone in 22.8%, and 17.5% were observed. The preoperative angle of esotropia was smaller in the observation group (P = 0.04). The postoperative angle of esotropia was not statistically significant between botulinum toxin or surgery (P = 0.3), although the age of intervention was earlier in the botulinum group (P = 0.007). Early intervention (before 12 months of age) did not influence the post-intervention motor outcomes between 0 and 10 prism dioptres of esotropia (P = 0.78).ConclusionsThe incidence of EIE in the UK is considerably lower than reported in other population-based studies. The preferred method of treatment was surgical with earlier intervention in those treated with botulinum toxin. An early age of intervention (<12 months) did not influence motor outcomes.
| S-EPMC10920776 | biostudies-literature
Project description:BackgroundIn Japan, oral propranolol (PPL) and pulsed dye laser are available for infantile hemangioma (IH) treatment without patient cost-sharing. However, no standardized algorithm exists to guide treatment selection that balances efficacy, potential side effects, and aesthetic risks. This study presents a comprehensive approach utilizing a treatment algorithm and aesthetic risk scoring system.MethodsThis retrospective study analyzed outcomes from 156 patients with IHs. Oral PPL was used in IH patients with functional issues, whereas the rest underwent an aesthetic risk assessment that categorized them into low-, moderate-, or high-risk groups to guide treatment choices. Final treatment decisions depended on parental preference. The outcomes of algorithm-compliant and noncompliant patients were compared statistically.ResultsThe risk score's interrater reliability was 0.973 (95% confidence interval 0.933-0.992), with a mean intrarater reliability of 0.968 ± 0.027 and a mean evaluation time of 14.1 ± 5.0 seconds per case. Among the 156 patients, 88% pursued the algorithm-recommended treatment, whereas 12% opted for different approaches. Algorithm-compliant patients experienced significantly fewer sequelae than did noncompliant patients (5% versus 33%, P < 0.001). Compared with noncompliant patients, algorithm-compliant patients tended to require shorter treatment durations (17.9 versus 25.4 mo, P = 0.08) and fewer laser sessions (5.8 versus 7.2, P = 0.30), with a younger age at resolution (21.3 versus 29.0 mo, P = 0.08).ConclusionsAesthetic concerns can be crucial for patients with IHs. This study introduces a comprehensive IH management algorithm to reduce the sequelae requiring surgical interventions and improve patients' quality of life.
| S-EPMC11412708 | biostudies-literature