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Updated: Jun 1, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Influence of timing of initial surgery for infantile esotropia on the severity of dissociated vertical deviation
Teiji Yagasaki1,2, Yoshimi O Yokoyama3, Mariko Maeda3
1Yagasaki Eye Clinic, 62-6 Kaimei Gonaka, Ichinomiya, 494-0001, Japan. y-teiji@jb3.so-net.ne.jp.
Insights
Early surgery for infantile esotropia improves outcomes by reducing the severity of dissociated vertical deviation (DVD) and decreasing the need for further operations.
Area of Science:
- Ophthalmology
- Pediatric ophthalmology
- Strabismus surgery
Background:
- Infantile esotropia is a common form of strabismus in children.
- Dissociated vertical deviation (DVD) is a commoncomitant strabismus.
- The optimal timing for surgical intervention remains a topic of investigation.
Purpose of the Study:
- To investigate the impact of initial surgery timing on sensory outcomes in infantile esotropia.
- To determine if early surgical intervention affects the severity of dissociated vertical deviation (DVD).
Main Methods:
- Retrospective analysis of 55 children (≤8 years) who underwent esotropia surgery.
- Patients categorized into three groups based on age at surgery: very early (birth-8 months), early (9-24 months), and late (≥25 months).
- Statistical evaluation of sensory and motor outcomes, including DVD incidence and manifestation.
Main Results:
- No significant overall difference in DVD incidence among groups.
- Very early surgery group exclusively had latent DVD; late surgery group had 38.9% manifest DVD.
- Significant differences observed in manifest vs. latent DVD proportions and need for additional surgery (p < 0.05).
Conclusions:
- Early surgical intervention for infantile esotropia is associated with decreased DVD severity.
- Timely surgery reduces the likelihood of manifest DVD and the need for subsequent operations.
Purpose:
The purpose of this study was to clarify whether the timing of initial surgery for infantile esotropia contributes to better sensory outcomes and to the severity of dissociated vertical deviation (DVD).
Methods:
This retrospective study examined 55 children, aged 8 years and younger, who underwent esotropia surgery. Based on age at the time of the surgery, patients were divided into the very early surgery group (birth to 8 months, N = 14), early surgery group (9-24 months, N = 23) and late surgery group (25 months and older, N = 18). Sensory and motor outcomes of the three groups were statistically evaluated.
Results:
No significant differences in the incidences of DVD were noted among the three groups at the final visit. However, all DVDs of the very early surgery group were latent, whereas 38.9% of the DVDs for both near and distance of the late surgery group were manifest. Significant differences were found among the three groups for the proportion of patients with manifest DVD, latent DVD and without DVD, and for the incidence of additional surgery for manifest DVD (p < 0.05, G-test).
Conclusion:
Early surgery for infantile esotropia decreases the severity of DVD and lowers the need for an additional operation for DVD.