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Dissociated vertical deviation and its relationship with time and type of surgery in infantile esotropia
Umut Arslan1, Huban Atilla, Necile Erkam
1Ankara University, Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey.
Insights
Early surgery for infantile esotropia reduces the risk of developing dissociated vertical deviation (DVD). Delayed or no surgery, or needing further muscle operations, increases the likelihood of DVD in children.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Research
Background:
- Infantile esotropia is a common childhood eye misalignment.
- Dissociated vertical deviation (DVD) is a potential complication affecting visual outcomes.
- Understanding DVD development is crucial for effective infantile esotropia management.
Purpose of the Study:
- To examine the incidence of DVD in infantile esotropia.
- To assess the relationship between DVD development and patient age at intervention.
- To investigate the impact of surgical techniques on DVD occurrence.
Main Methods:
- Retrospective review of medical records for infantile esotropia patients.
- Data collection on patient age, risk factors, and pre/post-treatment examinations.
- Comparison of treatment modes, including surgical intervention timing and techniques.
Main Results:
- DVD developed in 47.9% of cases, with higher incidence (80.5%) in non-surgically treated patients.
- Early surgical treatment (6 months-2 years) showed a significantly lower DVD rate (24.1%) compared to later treatment (>2 years, 52%).
- Surgical technique (bimedial recession vs. unilateral recession/resection) did not significantly impact DVD development.
Conclusions:
- Early surgical intervention for infantile esotropia is associated with a reduced risk of DVD.
- Delayed surgery, no surgery, or need for additional muscle surgery increases DVD incidence.
- Prioritizing early surgical correction aids in achieving binocularity and preventing amblyopia while minimizing DVD risk.
Aim:
To investigate the development of dissociated vertical deviation (DVD) in infantile esotropia and its relationship with the infant's age and the surgical intervention technique.
Material And Method:
The medical records of the patients that were diagnosed with infantile esotropia and followed-up in the Strabismus Department of our clinic (Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey) were reviewed retrospectively. The patients' ages at the time of admission, risk factors, ophthalmological examinations before and after treatment, and treatment mode were recorded and compared.
Results:
DVD was found to develop in approximately one-half of the cases (47.9%) at an average age of 3.2 years (20 months-5.5 years) regardless of the type of treatment. DVD developed in 80.5% of cases that had no surgery and in 37.5% of cases who were surgically treated. On comparison according to age, DVD was seen in 24.1% of the cases that were treated between ages 6 months and 2 years and in 52% of the cases that were treated after age 2 years. The difference was found to be statistically significant (p<0.01). On comparison according to the surgical technique, DVD developed in 34.8% of the cases who had undergone bimedial rectus recession and in 38% of the cases with unilateral recession and resection. This difference was not statistically significant (p>0.05).
Conclusions:
In the treatment of infantile esotropia, early surgical intervention to obtain binocularity and prevent amblyopia is associated with a reduced incidence of the development of DVD. It is concluded that the incidence of the development DVD increases if surgery is not performed, if performed at a later age, or if additional muscle surgery is needed during follow-up due to undercorrection.
