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Long-term postoperative stability in infantile esotropia
1Department of Orthoptics, University of Liverpool, School of Health Sciences, Faculty of Medicine, Liverpool, United Kingdom. rowef@liverpool.ac.uk
Insights
Early surgery for infantile esotropia (eye misalignment) in children can lead to cosmetically acceptable results. However, achieving full binocular vision is less common, with persistent amblyopia negatively impacting outcomes.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Infantile esotropia is a common form of strabismus in young children.
- Early surgical intervention is often recommended to improve alignment.
- Long-term outcomes regarding binocular vision and visual function require further investigation.
Purpose of the Study:
- To evaluate the ocular motility status and long-term outcomes in patients with infantile esotropia.
- To assess the success of surgical correction performed before two years of age.
- To identify factors associated with successful postoperative binocular vision.
Main Methods:
- Retrospective review of 40 children diagnosed with infantile esotropia.
- Surgical intervention performed before the age of two years (average 17 months).
- Minimum follow-up period of 4 years, including ophthalmology and orthoptic review.
Main Results:
- 60% of patients achieved a small-angle, cosmetically acceptable strabismus.
- 22.5% achieved some form of postoperative binocular vision (microtropia, intermittent exotropia, bifoveal exophoria).
- Persistent postoperative amblyopia was significantly linked to poorer outcomes and lack of binocular function.
Conclusions:
- Surgical correction of infantile esotropia before age two can yield favorable cosmetic results.
- Achieving robust binocular vision remains a challenge, with potential impact from the timing of onset and persistent amblyopia.
- Further research into factors influencing stereopsis development is warranted.
Abstract:
The purpose of this paper is to present the ocular motility status of a group of patients with infantile esotropia who underwent surgery before 2 years of age and were followed for a minimum period of 4 years until discharge from Ophthalmology and Orthoptic review. This retrospective review included 40 children with a diagnosis of infantile esotropia. There were 22 females and 18 males. The children were identified from surgical records between 1987 and 1992. Each child had surgery before the age of 2 years at an average age of 17 months (7 months to 22 months). Many patients (60%) achieved a small-angle (less than 20 prism dioptres), cosmetically acceptable strabismus. Nine patients (22.5%) achieved binocular vision postoperatively, five with microtropia, one with intermittent exotropia and three with bifoveal exophoria. The bifoveal patients did not exhibit high grade stereopsis, which may relate to the time of onset of infantile esotropia when development of cortical stereopsis is critical. Persistent amblyopia postoperatively was significantly associated with a poorer outcome and lack of binocular function.