Horizontal Incomitance and Anisocoria in Congenital Esotropia
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Abstract
Introduction: When exploring horizontal version movements, the pathways integrating Slow Eye Movements (SEMs) are analyzed, and when exploring pupil behavior, the pupillary pathway is analyzed. In healthy patients, the horizontal version trajectory is concomitant and the difference in size between both pupils is usually not significant, however, in Congenital Esotropia (CE), differences can be significant.
Objective: Identify if the type of horizontal incomitance is related to the degree of anisocoria in CE.
Materials and Methods: A prospective, cross-sectional, and experimental study was conducted on patients diagnosed with CE from Querétaro, Mexico. Infrared Video-oculography was performed under scotopic conditions (0.3 lux). Signs of congenital stigma such as Dissociated Vertical Deviation (DVD) and Latent Nystagmus (NL) were sought; likewise, the type of Horizontal Incomitance (IH) was classified according to motor behavior. Pupil area was measured using Voxel-based morphometry (VBM) and anisocoria was classified. The results were statistically analyzed.
Results: 53 patients aged 5 to 14 years were recruited: 22 boys and 31 girls. 21 patients presented with DVD and 25 with NL. All patients showed abduction limitations to varying degrees. IH had an incidence of 0.698, NL 0.471, DVD 0.396, Passive Horizontal Incomitance (PHI) 0.377, Active Horizontal Incomitance (AHI) 0.320, and No Horizontal Incomitance (NHI) 0.301.
Discussion: Both anisocoria and incomitance occur in CE. It is the first time the type of horizontal incomitance has been related to the degree of anisocoria. The analysis suggests a relationship between anisocoria and the type of incomitance, establishing differences between forms with and without Ciancia of CE. This contributes to decision-making and guides diagnosis, as well as prognosis.
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References
2. Passingham RE, Lau H. Do we understand the prefrontal cortex? Brain Struct Funct. 2023;228(5):1095-1105. Doi:10.1007/s00429-022-02587-7
3. Tychsen L, Boothe RG. Latent fixation nystagmus and nasotemporal asymmetries of motion visually evoked potentials in naturally strabismic primate. J Pediatr Ophthalmol Strabismus. 1996;33(3):148-152.
4. Gallegos-Duarte M, Moguel-Ancheita S. Características de la incomitancia horizontal en la endotropia congénita. Published online 2015. Doi:10.13140/RG.2.1.1853.7689
5. Gallegos-Duarte M. Fenómeno en bola de billar: descripción de un hallazgo clínico. Rev Mex Oftalmol. 1996;70(5):188-192.
6. Ghasia F, Tychsen L. Horizontal and vertical optokinetic eye movements in macaque monkeys with infantile strabismus: directional bias and crosstalk. Invest Ophthalmol Vis Sci. 2014;55(1):265-274. Doi:10.1167/iovs.13-12330
7. Gallegos-Duarte M, Moguel-Ancheita S, Rubín De Celis-Monteverde B. Análisis etiopatogénico del nistagmus de la mirada lateral. Published online 2015. Doi:10.13140/RG.2.1.2384.9687
8. A A, A D, V G, et al. Binocular Function in Different Gaze Positions. Journal of ophthalmic & vision research. 2022;17(2). Doi:10.18502/jovr.v17i2.10792
9. Gallegos-Duarte M. Stigma and origin of congenital esotropia | Estigma y origen de la endotropía congénita. Revista Mexicana de Oftalmologia. 2005;79(1):10-16.
10. Gallegos-Duarte M. Maniobras exploratorias en la endotropia congénita. Published online 2007. Doi:10.13140/RG.2.1.2418.2244
11. Tarnutzer AA, Straumann D. Nystagmus. Curr Opin Neurol. 2018;31(1):74-80. Doi:10.1097/WCO.0000000000000517
12. Ciancia AO. On infantile esotropia with nystagmus in abduction. J Pediatr Ophthalmol Strabismus. 1995;32(5):280-288.
13. Ciancia AO, Oliveri NC, Zabalo S. Oblique Muscle Overaction and Anisotropia in Infantile Esotropia with Abduction Nystagmus. American Orthoptic Journal. Published online January 1, 1992. Accessed February 16, 2024. https://www.tandfonline.com/doi/abs/10.1080/0065955X.1992.11981886
14. Romero-Apis D. Características clínicas de la desviación horizontal disociada / Clinical features of the dissociated horizontal deviation. Arch Chil Oftalmol. 1993;50(1):311-314.
15. Gallegos Duarte M. What’s with the anisocoria? EC Neurology. 2017;6(2):29-30.
16. Gallegos-Duarte M, Ramírez-Neira P, Ponce De León-Mon D, Gutierrez-Álvarez IA, Sosa-Ferreyra CF. Anisocoria y estrabismo congénito. Published online 2015. Doi:10.13140/RG.2.1.4040.2403
17. Gallegos-Duarte M, Mendiola-Santibañez JD. Anisocoria y Desviación Vertical Disociada. Published online 2013. Doi:10.13140/RG.2.1.2317.3849
18. Gallegos-Duarte M, Mendiola-Santibanez JD, Ibrahimi D, Paredes-Orta C, Rodriguez-Resendiz J, Gonzalez-Gutierrez CA. A Novel Method for Measuring Subtle Alterations in Pupil Size in Children With Congenital Strabismus. IEEE Access. 2020;8:125331.
19. Gallegos-Duarte M, Gutierrez-Álvarez IA. Teoría General de la Disincronía. Memorias del XIII Congreso del Consejo Latinoamericano de Estrabismo CLADE. Published online 1998:175-179. Doi:10.13140/RG.2.1.1805.3848
20. Gallegos-Duarte M, Moguel-Ancheita S, Rubin de Celis-Monteverde B. Etiopatogenia del nistagmo de la mirada lateral en la endotropia congénita. Sus características y posibiliades de tratamiento. Rev Mex Oftalmol. 2004;78(5):219-223.
21. Gallegos-Duarte M, Moguel-Ancheita S. Participación y neuromodulación de la corteza en un caso de estrabismo disociado y epilepsia. Archivos Chilenos de Oftalmología. 2006;63(2):199-209.
22. Brigo F, Alessandrini F, Ragnedda G, et al. Epileptic ictal strabismus: a case report and review of the literature. Epileptic Disord. 2018;20(4):283-288. Doi:10.1684/epd.2018.0980
23. Mocorrea JA, Locascio IC. Fisiología y fisiopatología de la acomodación convergencia. Estrabismo acomodativo. In: Clínica y Cirugía del Estrabismo. El Ateneo; 1978:100-105.
24. Sánches-Valdés CM, Murillo-Correa CE, Baca-Ruiz AC. Aparición de desviación vertical disociada posterior a cirugía de endotropia no acomodativa. Rev Mex Oftalmol. 2004;78(3):118-121.
25. Romero-Apis D. Romero-Apis D. Endotropias. En: Romero-Apis D. Estrabismo. Aspectos Clínicos y Tratamiento. México, DF: Ed Dala S.A. de C.V.; 2010. p. 141.
26. Brodsky MC. The Role of Cortical Alterations in Infantile Strabismus. Strabismus. 2012;20(1):35-36. Doi:10.3109/09273972.2011.650817
27. Gallegos-Duarte M M. Dissociated Vertical Divergence. Strabismus. 2012;20(1):31-32. Doi:10.3109/09273972.2011.651769
28. Gallegos-Duarte M, Prieto-Díaz J. La llamada Esotropía Congénita. LEOP. 2013;IV # 16:19-20. Doi:10.13140/RG.2.1.4319.7922
29. Sanchez MM, Whitman MC. Genetics of strabismus. Front Ophthalmol (Lausanne). 2023;3:1233866. Doi:10.3389/fopht.2023.1233866
30. da Cruz Escaleira ALR, Kalogeropoulos D, Kalogeropoulos C, et al. Four Common Diseases Causing Sudden Blindness or Death in the Eye Emergency Department. Postgrad Med J. 2021;97(1146):256-263. Doi:10.1136/postgradmedj-2020-138163
31. Rootman MS, Dotan G, Konen O. Neuroimaging in Children with Ophthalmological Complaints: A Review. J Neuroimaging. 2021;31(3):446-458. Doi:10.1111/jon.12842