Effects of Surgical Timing on Surgical Success and Long-term Motor and Sensory Outcomes of Infantile Esotropia
Abstract
Purpose:
To investigate the effect of surgical timing on long-term motor and sensory outcomes in patients with infantile esotropia.
Methods:
The medical records of patients who underwent strabismus surgery for infantile esotropia were reviewed retrospectively. The patients were divided into three groups according to age at the time of surgery: early group (6 to 11 months), late group (12 to 17 months), and very late group (18 to 27 months). The main outcome measures were final alignment, surgical success rate (the angle of deviation at final follow-up of ≤ 10 prism diopters [PD] of esotropia, no exotropia and no need for reoperation), stereoacuity, visual acuity, and the number of reoperations required during the follow-up.
Results:
A total of 79 patients (44 female, 35 male) met the inclusion criteria. The surgical success rate was 25.9%, 23.1%, and 53.8% in the three groups, respectively (P = .035). After a mean follow-up of 96 months, the average number of operations per child was 1.7 ± 0.9, 1.6 ± 0.6, and 1.4 ± 0.6 in the three groups, respectively (P = .020). The measurable stereopsis rate was higher in the early group (37% vs 3.8% and 3.8%, respectively) (P = .001). The amblyopia rate was similar between groups.
Conclusions:
The results show that performing surgery later in life in patients with infantile esotropia increases the motor success rate of surgery. In addition, orthophoria is achieved with fewer surgical operations. However, earlier surgery may improve stereopsis.
[J Pediatr Ophthalmol Strabismus. 2020;57(5):319–325.]
- 1.Costenbader FD. Infantile esotropia. Trans Am Ophthalmol Soc. 1961; 59:397–429. Medline, Google Scholar
- 2.von Noorden GK. A reassessment of infantile esotropia. XLIV Edward Jackson memorial lecture. Am J Ophthalmol. 1988; 105(1):1–10.
10.1016/0002-9394(88)90113-4 Crossref Medline, Google Scholar - 3.Pediatric Eye Disease Investigator Group. The clinical spectrum of early-onset esotropia: experience of the Congenital Esotropia Observational Study. Am J Ophthalmol. 2002; 133(1):102–108. Medline, Google Scholar
- 4.Pediatric Eye Disease Investigator Group. Spontaneous resolution of early-onset esotropia: experience of the Congenital Esotropia Observational Study. Am J Ophthalmol. 2002; 133(1):109–118. Medline, Google Scholar
- 5.Birch EE, Wang J. Stereoacuity outcomes after treatment of infantile and accommodative esotropia. Optom Vis Sci. 2009; 86(6):647–652.
10.1097/OPX.0b013e3181a6168d Crossref Medline, Google Scholar - 6.Mocan MC, Azar N. Surgical timing for infantile esotropia. Int Ophthalmol Clin. 2005; 45(4):83–95.
10.1097/01.iio.0000177428.43904.bf Crossref Medline, Google Scholar - 7.Ing MR. Surgical alignment prior to six months of age for congenital esotropia. Trans Am Ophthalmol Soc. 1995; 93:135–141. Medline, Google Scholar
- 8.Helveston EM, Neely DF, Stidham DB, Wallace DK, Plager DA, Sprunger DT. Results of early alignment of congenital esotropia. Ophthalmology. 1999; 106(9):1716–1726.
10.1016/S0161-6420(99)90337-8 Crossref Medline, Google Scholar - 9.Çerman E, Eraslan M, Ögüt MS. The relationship of age when motor alignment is achieved and the subsequent development of stereopsis in infantile esotropia. J AAPOS. 2014; 18(3):222–225.
10.1016/j.jaapos.2013.12.017 Crossref Medline, Google Scholar - 10.Parks MM, Wheeler MB. Concomitant esodeviation. In: , eds. Clinical Ophthalmology. JB Lippincott; 1991:10. Google Scholar
- 11.Louwagie CR, Diehl NN, Greenberg AE, Mohney BG. Long-term follow-up of congenital esotropia in a population-based cohort. J AAPOS. 2009; 13(1):8–12.
10.1016/j.jaapos.2008.06.013 Crossref Medline, Google Scholar - 12.Trigler L, Siatkowski RM. Factors associated with horizontal reoperation in infantile esotropia. J AAPOS. 2002; 6(1):15–20.
10.1067/mpa.2002.120644 Crossref Medline, Google Scholar - 13.Simonsz HJ, Kolling GH, Unnebrink K. Final report of the early vs. late infantile strabismus surgery study (ELISSS), a controlled, prospective, multicenter study. Strabismus. 2005; 13(4):169–199.
10.1080/09273970500416594 Crossref Medline, Google Scholar - 14.Birch E, Stager D, Wright K, Beck RPediatric Eye Disease Investigator Group. The natural history of infantile esotropia during the first six months of life. J AAPOS. 1998; 2(6):325–328.
10.1016/S1091-8531(98)90026-X Crossref Medline, Google Scholar - 15.Gursoy H, Basmak H, Sahin A, Yildirim N, Aydin Y, Colak E. Long-term follow-up of bilateral botulinum toxin injections versus bilateral recessions of the medial rectus muscles for treatment of infantile esotropia. J AAPOS. 2012; 16(3):269–273.
10.1016/j.jaapos.2012.01.010 Crossref Medline, Google Scholar - 16.Ing MR, Norcia A, Stager D, A prospective study of alternating occlusion before surgical alignment for infantile esotropia: one-year postoperative motor results. J AAPOS. 2006; 10(1):49–53.
10.1016/j.jaapos.2005.09.006 Crossref Medline, Google Scholar - 17.Louwagie CR, Diehl NN, Greenberg AE, Mohney BG. Is the incidence of infantile esotropia declining?: A population-based study from Olmsted County, Minnesota, 1965 to 1994. Arch Ophthalmol. 2009; 127(2):200–203.
10.1001/archophthalmol.2008.568 Crossref Medline, Google Scholar - 18.Ing MR. Early surgical alignment for congenital esotropia. Ophthalmology. 1983; 90(2):132–135.
10.1016/S0161-6420(83)34586-3 Crossref Medline, Google Scholar - 19.Birch EE, Stager DR, Everett ME. Random dot stereoacuity following surgical correction of infantile esotropia. J Pediatr Ophthalmol Strabismus. 1995; 32(4):231–235. Link, Google Scholar
- 20.Birch EE, Fawcett S, Stager DR. Why does early surgical alignment improve stereoacuity outcomes in infantile esotropia?J AAPOS. 2000; 4(1):10–14.
10.1016/S1091-8531(00)90005-3 Crossref Medline, Google Scholar
