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Published on: March 24, 2020
The timing of surgical alignment for congenital (infantile) esotropia
1Department of Surgery, John A. Burns School of Medicine Honolulu, Hawaii 96826-1032, USA.
Insights
Early alignment for congenital esotropia may offer better binocularity, but refined stereoacuity remains challenging. Careful follow-up is crucial to manage potential complications and achieve optimal surgical outcomes.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Accurate alignment by age 2 is established for congenital esotropia.
- Limited evidence exists for improved binocularity with alignment before age 1, especially before 6 months.
- Early intervention for congenital esotropia presents potential challenges.
Purpose of the Study:
- To evaluate the potential benefits of very early alignment (before age 1) in congenital esotropia.
- To assess if earlier alignment improves the quality of binocularity, specifically refined stereoacuity.
- To identify potential pitfalls and management needs associated with early surgical alignment.
Main Methods:
- Review of clinical evidence regarding timing of surgical alignment for congenital esotropia.
- Analysis of outcomes related to binocularity and stereoacuity based on age at alignment.
- Identification of common complications and re-operation rates.
Main Results:
- While alignment by age 2 is beneficial, evidence for superior outcomes with earlier alignment is scarce.
- Refined stereoacuity is rarely achieved, even with optimal alignment, often remaining within monofixation syndrome limits.
- Early alignment requires vigilant monitoring for vertical motor defects, amblyopia, and refractive errors.
Conclusions:
- Optimal surgical outcomes in congenital esotropia typically result in monofixation syndrome, with refined stereoacuity being an uncommon achievement.
- Very early alignment (before 6 months or 1 year) may not consistently yield significantly better binocularity or stereoacuity compared to alignment by age 2.
- Ongoing ophthalmological vigilance and management of potential complications are essential for patients undergoing early or conventional alignment for congenital esotropia.
Abstract:
At this time, the beneficial effect of accurate alignment by age 2 in congenital esotropia has been well established by clinical and laboratory studies. There is, however, only scanty clinical evidence that alignment before age 1, much less before 6 months of age, may yield a better quality of binocularity (i.e., refined stereoacuity) than alignment by age 2. Pitfalls of very early alignment are present. In addition, the ophthalmologist must be vigilant in following the initially aligned patient and be ready to treat vertical motor defects, amblyopia, and acquired refractive errors. The need for additional horizontal surgery after initial alignment is also common. The optimum result in the surgical treatment of congenital esotropia generally shows binocularity that is within the confines of a monofixation syndrome, and refined stereoacuity remains an elusive target and a rare outcome, no matter at what age the alignment is achieved.
