Three horizontal muscle squint surgery for large angle infantile esotropia

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Strabismus Surgery

Background:

• Infantile esotropia is a common condition requiring surgical intervention.
• Large angle infantile esotropia (> or =60 Delta) presents a significant challenge in surgical management.
• Long-term outcomes of surgical interventions for this condition are crucial for treatment planning.

Purpose of the Study:

• To evaluate the long-term efficacy of three horizontal muscle surgery for large angle infantile esotropia.
• To determine the cumulative success rate and failure modes over an extended follow-up period.
• To propose surgical guidelines based on the study's findings.

Main Methods:

• Retrospective review of 49 consecutive patients with large angle infantile esotropia.
• Surgery involved bilateral medial rectus recession and graded unilateral lateral rectus resection.
• Mean follow-up period of 32.9 months, with data analyzed using Kaplan-Meier life-table analysis.

Main Results:

• Cumulative surgical success (orthotropia +/-10 Delta) remained high, reaching 70.6% at 6 years.
• The failure rate was independent of the preoperative deviation angle.
• Prevalence of residual esotropia and consecutive exotropia increased over time but remained manageable.

Conclusions:

• Graded three horizontal muscle surgery is a highly successful treatment for large angle infantile esotropia.
• The surgical approach demonstrates sustained efficacy over long-term follow-up.
• The study provides data to inform surgical dose for specific strabismus angles.