[Early surgery in infantile esotropia]

Area of Science:

• Ophthalmology
• Pediatric Surgery
• Strabismus Research

Background:

• Infantile esotropia surgery timing is controversial, particularly regarding its impact on binocularity.
• Early surgery is defined as intervention before 2 years for strabismus with onset before 4 months.
• North American belief suggests earlier surgery yields better binocularity, contrasting European findings.

Purpose of the Study:

• To compare binocular function outcomes in patients undergoing early versus late surgery for infantile esotropia.
• To evaluate the number of surgical interventions required in early versus late treatment groups.

Main Methods:

• A European multicenter study compared early surgery (6-24 months) with late surgery (32-60 months) in infantile esotropia patients.
• Patient outcomes were assessed at 6 years of age.
• Binocular functions and postoperative alignment were key outcome measures.

Main Results:

• While early surgery showed slightly better binocular function, most patients in both groups had subnormal or anomalous binocularity.
• Achieving equivalent postoperative alignment required more operations in the early surgery group.
• Concerns exist that extremely early surgery may include undiagnosed intermittent strabismus, potentially skewing results.

Conclusions:

• The study suggests that early surgery for infantile esotropia does not guarantee normal binocular single vision.
• Very early intervention increases the likelihood of requiring multiple surgical procedures.
• The optimal age for infantile esotropia surgery remains an open question requiring further investigation.