The authors aimed to provide a better understanding of the clinical spectrum of infantile esotropia by comparing motor and sensory results in the long-term follow-up of patients who underwent surgery. This was a retrospective review over a 17-year period. There were 44 females and 35 males who met the inclusion criteria. Group 1 (n=27) had early surgery at six to 11 months. Group 2 (n=26) had late surgery at 12-17 months and group 3 (n=26) had very late surgery at 18-27 months. Mean age at first examination was 7.6 ±1.8, 12.2 ±3.4 and 15 ±6 months for groups 1-3 respectively. Mean horizontal angle at baseline for all was 50.9 ±14PD and refraction was +1.77D. Mean age for first operation was 8.5 ±1.5, 14.4 ±2 and 20.9 ±3.1 months respectively. Mean follow-up overall was 96.6 ±40 months. There was no significant difference between groups for angle of deviation, refraction and follow-up. At baseline, six had nystagmus, 35 had inferior oblique overaction, four had V pattern, 27 had cross fixation, seven had dissociated vertical deviation (DVD) and one had an abnormal head posture. These were distributed across all age groups. Mean final angle was 16 ±10.6, 11.4 ±8.7 and 10.7 ±9PD respectively and differences were not significant. Surgical success was 25.9%, 23.1% and 5.8% respectively. Thirty-five (44.3%) needed a second procedure. Amblyopia was found in 37 patients with similar rates across groups. Twelve patients had measurable stereopsis which was significantly greater in group 1. The authors concluded that surgery at older than 18 months increased the chance of motor success with fewer surgical operations. However, earlier surgery may improve stereopsis development.
Outcomes of early versus late surgery for infantile esotropia
Reviewed by Fiona Rowe
Effects of surgical timing on surgical success and long-term motor and sensory outcomes of infantile esotropia.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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