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The relationship of age when motor alignment is achieved and the subsequent development of stereopsis in infantile
Eren Çerman1, Muhsin Eraslan1, Mehdi S Öğüt1
1Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey.
Insights
For infantile esotropia, surgery before 16 months of age is crucial for developing stereopsis. Achieving excellent motor alignment after this age significantly reduces the chances of regaining binocular vision.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Infantile esotropia is a common form of strabismus in young children.
- Early intervention is critical for visual development, including stereopsis.
- The optimal age for surgical correction to achieve the best visual outcomes remains a key question.
Purpose of the Study:
- To identify the critical age threshold for surgical intervention in infantile esotropia to achieve measurable stereopsis.
- To determine the oldest age at which successful stereopsis development is still possible despite optimal motor alignment.
Main Methods:
- Retrospective review of medical records of 38 children with infantile esotropia who underwent a single surgery.
- Analysis of patients with alignment within 10 prism diopters of orthotropia post-surgery.
- Assessment of stereopsis in patients older than 48 months, correlating it with age at surgery.
Main Results:
- A statistically significant inverse correlation was found between age at surgery and final stereopsis.
- The optimal cut-off age for predicting successful stereopsis was determined to be 16 months.
- Patients operated on before 16 months showed significantly better stereopsis outcomes compared to older patients.
Conclusions:
- Surgical alignment for infantile esotropia should ideally be performed at or before 16 months of age to maximize the potential for developing stereopsis.
- Delaying surgery beyond 16 months significantly diminishes the likelihood of achieving functional stereopsis, even with perfect eye alignment.
Purpose:
To determine the oldest age beyond which the chance of developing stereopsis is not possible even with excellent motor alignment in patients with infantile esotropia.
Methods:
The medical records of children with infantile esotropia who underwent a single operation and had alignment within 10(Δ) of orthotropia at all follow-up examinations were retrospectively reviewed. Patients were assessed for stereopsis after the age of 48 months.
Results:
A total of 38 children were included. There was a statistically significant inverse correlation between age at surgery and final stereopsis (r = 0.494, P = 0.002). There was a significant difference at mean age at surgery between patients having stereopsis better than 1000 arcsec and those having no stereopsis (P = 0.002). Post hoc power analysis revealed a value of 85%. Receiver operating characteristic curve analysis revealed that the optimum cut-off value of the age at surgery for predicting stereopsis was 16 months (Youden index = 0.474; area under ROC curve, 0.784; 95% CI: 0.62-0.90; P = 0.0002).
Conclusions:
Surgery for infantile esotropia is most likely to result in measureable stereopsis if patient age at alignment is not more than 16 months.
