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Early versus late alignment of infantile esotropia
1Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK.
Insights
Early surgery for infantile esotropia (eye misalignment) improves chances of binocular vision. Older children achieve alignment but have lower rates of developing binocularity, with more V-pattern deviations.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Infantile esotropia is a common form of strabismus in children.
- Surgical intervention is a primary treatment for infantile esotropia.
Purpose of the Study:
- To compare the outcomes of early (before 2 years) versus late (2-7 years) surgical correction of infantile esotropia.
- To analyze the impact of surgical timing on motor alignment and sensory (binocular) states.
Main Methods:
- Retrospective review of 101 children with infantile esotropia who underwent surgical correction.
- Analysis of motor alignment (within 10 prism diopters) and sensory states before and after surgery.
- Comparison of outcomes between patients operated before and after two years of age.
Main Results:
- Successful alignment was achieved in 70 out of 101 patients.
- Patients undergoing surgery at two years or older had good alignment but a lower chance of achieving binocularity.
- Younger patients (under two years) showed a better chance of attaining binocularity and fewer required surgery for V-pattern deviations.
Conclusions:
- While late surgical correction can achieve alignment in infantile esotropia, early intervention is associated with better outcomes for binocular vision development.
- The timing of surgical correction significantly influences the potential for developing binocularity in infantile esotropia.
- Infantile esotropia requiring inferior oblique muscle surgery may be less prevalent with earlier surgical intervention.
Abstract:
Fifty-two children with infantile esotropia had surgery for their esotropia between two and seven years of age. Another 49 had similar surgery before the age of two years. Of these 101 operated children, the esotropia in 70 patients was aligned to within 10 prism diopters. The patients with successful alignment were reviewed to study the effect of early versus late surgical intervention of their deviation, i.e. before and after two years of age. The motor and sensory states of the selected patients were analysed before and after surgical correction. The choice and number of surgical procedures employed are discussed. It appears that patients two years and older when strabismus was surgically corrected have a good chance of alignment, but less chance of attaining binocularity. In many cases there was a V-pat-tern esotropia, requiring surgery on the overacting inferior oblique muscles. In comparison, the younger group with earlier surgery appeared to show a better chance of attaining binocularity and fewer patients had significant V-pattern requiring surgery on the inferior oblique muscles.
