Study On The Pathogenesis Of Concomitant Esotropia And Clinical Treatment Of Acute Acquired Comitant Esotropia

Part Ⅰ:Study on the pathological changes of extraocular muscles in concomitant esotropiaObjective:To observe the pathological changes of the rectus muscle of concomitant esotropia,and to explore the pathogenesis of concomitant esotropia.Methods:From Jan.2016 to Sep.2017,62 cases of hospitalized patients of strabismus and pediatric ophthalmology professional group in the ophthalmology center of The First Aaffiliated Hospital of Zhengzhou University were collected and divided into congenital esotropia group(25 cases),acute concomitant esotropia group(25 cases)and normal control group(12 cases).The laternal rectus muscle of the patients with strabismus was amputated intraoperatively and the laternal rectus muscle of the control group was amputated intraoperatively.After the section was fixed,HE staining was performed to observe the morphological changes of the laternal rectus muscle and to measure the cross-sectional area of the muscle cells.Results:Patients with concomitant esotropia laternal rectus muscle fiber loose,irregular arrangement,wider gap,fiber necrosis atrophic pathological changes,such as acute concomitant esotropia group of muscle fiber cross-sectional area(329.90+17.74)μm2,congenital esotropia group of muscle fiber cross-sectional area(226.50+21.37)μm2,adult controls muscle fiber cross-sectional area(835.00+77.78)μm2,two comparison between three groups,the difference was statistically significant(P<0.001).The cross-sectional area of muscle fibers(328.50±9.95)μm2 was slightly decreased in children with acute concomitant esotropia compared with adults(330.83±22.45)μm2,with no significant difference(P=0.852).The cross-sectional area of muscle fibers(231.38±21.18)μm2 in children with congenital esotropia increased by compared with that in adults(207.00±4.24)μm2,with statistically significant difference(P=0.159).Conclusions:In patients with concomitant esotropia,the muscle fibers of the laternal rectus muscle were atrophic and decreased,which was not affected by age.Therefore,the morphological changes of extraocular muscles may be related to the occurrence and development of strabismus.Part Ⅱ Changes of IGF-1 and NGF gene expression and protein expression in the weak lateral extraocular muscle in patients with concomitant esotropiaObjective:To investigate the mRNA and protein expression differences of IGF-1 and NGF in the rectus muscle of concomitant esotropia,and to investigate the role of IGF-1 and NGF in the etiology of concomitant esotropia.Methods:Sixty-two cases of hospitalized patients in ophthalmology center of The First Aaffiliated Hospital of Zhengzhou University were collected,including 25 cases in congenital esotropia group,25 cases in acute concomitant esotropia group and 12 cases in normal control group.The laternal rectus muscle amputated in strabismus;The control group was the laternal rectus muscle obtained during enucleation of the eyeball.The mRNA expression levels of NGF and IGF-1 in the laternal rectus muscle of concomitant esotropia were detected by polymerase chain reaction(PCR),and GAPDH was used as the internal control.The protein expressions of NGF and IGF-1 in the rectus muscle of concomitant esotropia were detected by Western-Blot and immunohistochemistry,and the values of immunohistochemical surface density between the groups were compared.Results:(1)NGF and IGF-1 mRNA and protein expression were observed in concomitant esotropia group and normal control group.(2)relative mRNA expression of NGF gene was 0.3775±0.022 in the congenital esotropia group,0.930±0.047 in the acute concomitant esotropia group,and 0.855±0.021 in the normal control group.Congenital esotropia group was significantly lower than the normal control group,while acute concomitant esotropia group was slightly higher than the normal control group.The relative mRNA expression of IGF-1 gene was 1.103±0.100 in the congenital esotropia group,1.969±0.142 in the acute concomitant esotropia group,and 1.655±0.092 in the normal control group.Congenital esotropia group was significantly lower than the normal control group,while acute concomitant esotropia group was slightly higher than the normal control group.(3)Western-Blot test results:congenital esotropia model NGF group and the amount of protein table of IGF-1 significantly lower than normal control group(P<0.001),acute concomitant esotropia model NGF group and the protein expression of IGF-1 quantity is slightly higher than normal control group(P>0.05),congenital esotropia model NGF group and the protein expression of IGF-1 acute concomitant esotropia group significantly decreased(P<0.001).(4)immunohistochemical results showed that the majority of NGF and IGF-1 protein expressions were located in the cytoplasm of muscle cells.The surface density of NGF immunohistochemical acute concomitant esotropia group was 0.0430±0.0062,which was higher than that of normal control group 0.0307±0.0020,and the difference was statistically significant(P=0.032).The surface density of IGF-1 immunohistochemical acute concomitant esotropia group was 0.0404±0.0062,which was higher than that of normal control group 0.0247±0.0058,and the difference was statistically significant(P=0.033).Immunohistochemistry of NGF and IGF-1 in congenital esotropia showed tissue necrosis.Conclusions:The relative mRNA expression and protein expression of NGF and igf-1 in acute concomitant esotropia group,congenital esotropia group and normal control group showed statistically significant differences.Changes in NGF and igf-1 expression are involved in the occurrence and progression of strabismus.Part Ⅲ Clinical characteristics of acute acquired comitant esotropia and analysis of botulinum toxin injection therapy and surgical treatmentObjective:To observe the clinical features of acute acquired comitant esotropia and compare the therapeutic effects of botulinum toxin injection and surgery on.Methods:The information of 29 patients with acute acquired comitant esotropia in the First Affiliated Hospital of Zhengzhou University(Henan Provincial Eye Hospital)from Jan 2016 to Jan 2017 were collected.The follow-up time was ≥6 months.According to the different treatment methods,they were divided into two groups:botulinum toxin type A injection group(group A,13 cases)and strabismus correction surgery group(group B,16 cases).The prism before and after treatment was compared,The proportion of the positive position is compared with the stereoscopic view.At the same time,in 29 patients,the relationship between different degrees of myopia and different type of acute comitant esotropia and the near and far deviation were analyzed.Results:Six months after surgery,the anteroposterior proportion in group A was 11/13 cases(84.62%),and that in group B was 13/16 cases(81.25%).There was no statistically significant difference between anteroposterior proportion in group A and that in group B(P>0.05).One day after surgery,the near-deviation in group A and group B was(14.76±10.57)PD and(0.66±3.19)PD,the far-deviation was(19.07±10.24)PD and(3.13=3.37)PD.One month after surgery,the near-deviation in group A and group B was(-1.92±7.13)PD and(3.93±1.83)PD.The far-strabismus was(1.69±7.04)PD and(6.20±1.93)PD.There was statistically significant difference between the two groups(P<0.05).Six month after surgery,the near-deviation in group A and group B was(5.92±7.72)PD and(4.60±2.29)PD.The far-strabismus was(6.84±6.28)PD and(5.26±3.03)PD.There was no statistically significant difference in postoperative strabismus between the two groups(P>0.05).Six month after surgery,11 patients in group A had near-stereoscopic vision,12 patients had far-stereoscopic vision,16 patients in group B had near-stereoscopic vision,and 16 patients had far-stereoscopic vision.There was no statistically significant difference between the two groups(P1=0.192,P2=0.448).In the group patients with myopia>2.5D,the far-deviation was(30.50±11.16)PD and near-deviation was(21.00±9.94)PD.The difference between far and near deviation was statistically significant(P=0.001).In the type II,near and far deviation was(67.50±20.61)PD and(71.25±17.50)PD.In the type III,near and far deviation was(39.80±18.79)PD and(32.00±22.22)PD,the difference between the two groups was statistically significant(P1=0.002;P2=0.012).Conclusions:The effect of botulinum toxin injection on acute concomitant esotropia A was comparable to that of surgery.Botox type A injection is relatively simple and can be used as an alternative treatment for acute comitant esotropia.Myopic degree>2.5 D group of patients see far strabismus degree greater than near the strabismus degree,II type patients with acute concomitant esotropia and strabismus degrees than III type and strabismus degrees in patients with acute concomitant esotropia.