Related Experiment Video
Updated: Aug 20, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Pre-operative stability of infantile esotropia and post-operative outcome
Eileen E Birch1, Joost Felius, David R Stager
1Retina Foundation of the Southwest, Dallas, Texas 75231, USA. ebirch@retinafoundation.org
Insights
Surgery for infantile esotropia may not require waiting for a stable angle of deviation. Both stable and unstable groups showed similar long-term alignment and sensory outcomes after surgical intervention.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Infantile esotropia is a common condition requiring timely management.
- The optimal timing for surgical intervention, particularly concerning the stability of the angle of deviation, remains an area of investigation.
Purpose of the Study:
- To determine the prevalence and temporal changes in the angle of deviation in infantile esotropia during the initial months post-diagnosis.
- To compare long-term ocular alignment and sensory outcomes in infants undergoing surgical alignment for stable versus unstable angles of deviation.
Main Methods:
- Prospective cohort study of 208 newly diagnosed infants with infantile esotropia.
- Preoperative angle of deviation measurements were taken at diagnosis and at ~6-week intervals until surgery.
- Postoperative outcomes included ocular alignment at 6 weeks, 1 year, and 4 years, and stereoacuity at ages 5–9 years.
Main Results:
- 57% of infants had stable esodeviations (within 10 prism diopters), 33% had unstable increases, and 11% had unstable decreases.
- Many patients shifted between stable and unstable categories during follow-up.
- Both stable and unstable preoperative groups demonstrated similar long-term postoperative alignment, re-operation rates, spectacle correction needs, and stereoacuity.
Conclusions:
- Waiting for a stable angle of deviation before surgical intervention for infantile esotropia may not be necessary.
- Surgical outcomes regarding alignment and sensory function are comparable regardless of preoperative angle stability.
Purpose:
To define the prevalence and time course of significant changes in angle of deviation during the first months after the diagnosis of infantile esotropia and to determine whether long-term alignment and sensory outcomes differ when surgical alignment is performed on infants with stable vs unstable angles of deviation.
Design:
Prospective cohort study.
Methods:
setting: Institutional and clinical practice. patient population: Newly diagnosed patients with infantile esotropia (N = 208). observation procedure: Preoperative measurements of the angle of deviation on the initial visit and at approximate six-week intervals until surgery was performed. main outcome measures: Ocular alignment at six weeks, one year, and four years postoperative and stereoacuity at age five to nine years.
Results:
Overall, 57% of infants had an esodeviation on the second visit that was within 10 prism diopters (p.d.) of the deviation measured on the initial visit (stable group), 33% had an increase of 10 p.d. or more (unstable group), and 11% had a decrease of 10 p.d. or more. Among the 127 patients with additional preoperative visits, many switched between the stable and unstable categories during follow-up. Long-term, stable and unstable preoperative alignment groups had similar postoperative motor alignment, re-operation rates, rates of prescription of hyperopic, or bifocal spectacle correction and stereoacuity.
Conclusions:
It may not be necessary to wait for a "stable" angle of esodeviation before surgery since both alignment and sensory outcomes were similar for stable and unstable groups.