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Esotropia surgery in children: long term outcome regarding changes in binocular alignment; a study of 956 cases
1Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, Japan.
Insights
Achieving orthotropia or minimal esotropia within 1 month post-surgery is crucial for long-term binocular alignment in esotropia patients. Avoiding overcorrection is strongly recommended for better surgical outcomes.
Area of Science:
- Ophthalmology
- Strabismus Surgery
- Pediatric Ophthalmology
Background:
- Esotropia, a condition of inward-turning eyes, can be congenital/infantile or acquired.
- Medial rectus muscle recession is a common surgical approach for esotropia.
Purpose of the Study:
- To determine the correlation between early (1-month) and long-term (4-year) surgical outcomes in esotropia.
- To assess the stability of eye alignment after strabismus surgery.
Main Methods:
- Retrospective review of 956 patients under 15 years of age who underwent medial rectus muscle recession.
- Analysis of patients with congenital/infantile and acquired esotropia over a 22-year period.
Main Results:
- Both esotropia types showed a slight tendency towards exotropia at 4 years post-surgery.
- Surgical success in terms of appearance was consistent between 1 month and 4 years.
- Patients with normal retinal correspondence or simultaneous perception had better 4-year binocular alignment.
Conclusions:
- Orthotropia or minimal esotropia at 1 month post-surgery is essential for achieving stable binocular alignment at 4 years.
- Avoiding overcorrection (consecutive exotropia) at the 1-month mark is critical for both congenital/infantile and acquired esotropia.
Purpose:
To study the correlation between the outcome at 1 month (when the postoperative eye position is at the earliest stabilized), and 4 years after surgery.
Method:
Retrospective review of medical records.
Cases:
The authors reviewed 956 patients under 15 years of age who underwent unilateral or bilateral recession of the medial rectus muscle during a 22 year period representing the entire practice period of the senior author since the department was founded in 1977. The series comprised 521 cases of congenital/infantile esotropia (manifest before 6 months of age with no accommodative component) and 435 cases of acquired esotropia (manifest after 6 months of age with no accommodative component or with an accommodative component but excluding those with a high AC/A ratio). A consistent surgical plan was employed throughout this period for each condition.
Results:
Both types of esotropia showed a slight tendency to become exotropic during the 4 years after surgery. There was no difference in general success with regard to the reconstructive restoration of normal appearance or improvement of appearance between 1 month and 4 years after surgery. Patients with normal retinal correspondence or simultaneous perception achieved better binocular alignments at the 4 year followup than those who did not have such sensory binocular cooperation.
Conclusions:
In infantile and acquired esotropia, it is essential that orthotropia or minimal esotropia be present at 1 month of surgery in order to obtain a binocular alignment within +/- 4 PD of orthotropia 4 years after surgery. It is strongly recommended to avoid overcorrection (consecutive exotropia) at 1 month after surgery for both congenital/infantile and acquired esotropia.
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