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Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Results of bilateral medial rectus recession for comitant esotropia in patients with developmental delay
Meenakshi Swaminathan1, Sanil V Shah, Shruti Mittal
1Department of Pediatric Ophthalmology, Medical Research Foundation , Chennai , India.
Insights
Strabismus surgery outcomes in children with developmental delay are unpredictable. These patients may experience an exaggerated response to standard bimedial recession, requiring adjusted surgical amounts for optimal results.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Developmental Pediatrics
Background:
- Limited literature exists on surgical outcomes for strabismus in children with developmental delay.
- Standard surgical tables' applicability in this population remains unclear.
- Esotropia is a common strabismus type requiring surgical intervention.
Purpose of the Study:
- To evaluate surgical outcomes of esotropia repair in patients with developmental delay.
- To compare surgical results between patients with and without developmental delay.
- To assess the applicability of standard surgical tables for this patient group.
Main Methods:
- Retrospective cohort study comparing patients with developmental delay (excluding Down syndrome) to a control group without developmental delay.
- Bimedial recession for comitant esotropia performed between 2005 and 2011.
- Comparison of operated angle of deviation, response to surgery, and success rates between groups.
Main Results:
- Patients with developmental delay showed an average of 72.13% of their angle of deviation operated, with a response of 134.06%.
- The control group had 89.08% of their angle operated, with a response of 89.83%.
- Successful outcomes (±10 PD orthophoria) were achieved in 60% of patients with developmental delay versus 73.58% in the control group.
Conclusions:
- Surgical outcomes for strabismus in patients with developmental delay are unpredictable.
- An exaggerated response to standard bimedial recession should be anticipated.
- Operating for approximately 70.67% of the angle of deviation may increase success rates in this population.
Purpose:
There is paucity of literature on surgical outcomes after strabismus surgery in patients with developmental delay. There is no consensus regarding whether standard surgical tables are applicable to these children. The goal of our study was to determine results of strabismus surgery for esotropia among these children.
Methods:
Two retrospective cohorts of patients, with developmental delay (excluding Down syndrome) and without developmental delay, who underwent bimedial recession for comitant eso-deviation between January 2005 and January 2011, meeting our criteria, were selected. Amount of surgery performed in these children was compared with standard table. This comparison gave us operated angle of deviation. This operated angle of deviation was expressed as percentage of preoperative angle of deviation to get amount of surgery performed. Response to surgery was defined as percentage of change in angle of deviation after surgery to the operated angle of deviation. Amount of surgery performed, response to surgery, and results were compared between two groups.
Results:
This study included 25 patients with developmental delay and 53 normal children with comitant esotropia. Age, refractive error, and preoperative angle of deviation were comparable in patients with and without developmental delay. Among patients with developmental delay, on average 72.13%±16.08 of angle of deviation was operated; response to surgery gained was 134.06%±51.62. In the control group, the average amount of surgery done was 89.08%±10.83; response gained was 89.83%±22.49. Successful outcome (±10 PD of orthophoria) was noted in 60% patients with developmental delay compared to 73.58% in control group. On average 70.67%±17.95 angle of deviation was operated in patients with developmental delay with successful outcome.
Conclusion:
Surgical outcome in patients with developmental delay is very unpredictable. An exaggerated response to standard amounts of bimedial recession should be anticipated in these patients. Though there was no statistically significant difference, operating for 70.67%±17.95 angle of deviation is more likely to be successful.
