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Results of early alignment of congenital esotropia
E M Helveston1, D F Neely, D B Stidham
1Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, 46202-5175, USA.
Insights
Early surgical correction for congenital esotropia can achieve initial alignment but often requires further procedures. Long-term outcomes include potential for strabismus, amblyopia, and refractive errors, with variable stereo acuity development.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Congenital esotropia is a common childhood eye misalignment.
- Early surgical intervention is a standard treatment approach.
Purpose of the Study:
- To evaluate the long-term motor and sensory outcomes following early surgical correction of congenital esotropia.
Main Methods:
- A case series of ten infants with congenital esotropia.
- Bimedial rectus recession surgery was performed between 83 and 159 days of age.
- Patients underwent regular follow-up and retreatment for strabismus, amblyopia, and refractive errors.
Main Results:
- Initial alignment was achieved in all patients; however, 70% required an average of 1.1 additional surgeries over 8-11 years.
- Visual acuity of 20/40 or better was achieved in 19 eyes.
- Four patients developed measurable stereo acuity, with two achieving 3000 seconds.
Conclusions:
- Bimedial rectus recession can align congenital esotropia in infants but does not guarantee sustained alignment.
- Patients often require further surgical or optical interventions and may develop associated conditions like dissociated vertical deviation or latent nystagmus.
- Stereo acuity development is influenced by alignment but also significantly by individual factors.
Objective:
To determine the long-term motor and sensory results after early surgical correction of patients with congenital esotropia.
Design:
Noncomparative interventional case series.
Participants:
Ten infants with congenital esotropia.
Intervention:
Patients had bimedial rectus recession between 83 and 159 days of age; were re-examined in a regular follow-up program; and were retreated when required for strabismus, amblyopia, and refractive errors.
Main Outcome Measures:
Final alignment, stereo acuity, variations in vision, alignment, refraction, and number and types of retreatments required during the period of observation.
Results:
All patients were aligned initially with bimedial rectus recession of 8.0 to 10.0 mm measured from the limbus. A total of 11 additional surgical procedures were performed on 7 patients to maintain alignment. Four patients required hyperopic spectacle correction to maintain alignment, and two patients required short periods of patching. Visual acuity was 20/40 or better in 19 eyes at the most recent examination, which was between 8.3 and 11.8 years after initial surgery. All patients had final alignment to within 10 prism diopters (PD) of orthotropia at either distance or near. Nine of ten patients had dissociated vertical deviation (DVD), and four of ten patients had latent nystagmus. Four patients had measurable stereo acuity at their last visit, with two achieving a stereo acuity of 3000 seconds (the Titmus fly), one 400 seconds, and one 140 seconds.
Conclusion:
Surgical alignment of congenital esotropia can be achieved in the 4-month-old with bimedial rectus recession, but this does not ensure continued alignment. At least one additional surgical procedure is required on average to maintain alignment in the first 10 years after initial successful surgery. These patients can also be expected to have one or more of the following: DVD, latent nystagmus, refractive component, or latent strabismus. Regardless of outcome, patients with congenital esotropia have optokinetic asymmetry. Attainment of stereo acuity, including high-grade stereo acuity, may be enhanced by attainment of orthotropia or small-angle esotropia but is likely to be ultimately dependent on constitutional factors rather than age of alignment.
