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Updated: Mar 17, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Long-term motor and sensory outcomes after surgery for infantile esotropia
Insights
Early surgical correction for infantile esotropia (ET) may increase the risk of developing dissociated vertical deviation (DVD) and the need for further surgery, despite limited impact on stereopsis.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Infantile esotropia (ET) is a common condition diagnosed within the first six months of life.
- Surgical correction is the primary treatment for ET.
- Long-term outcomes of early surgical intervention require further investigation.
Purpose of the Study:
- To evaluate the long-term motor and sensory outcomes of infantile esotropia (ET) after surgical correction.
- To determine the impact of the timing of initial surgery on outcomes such as dissociated vertical deviation (DVD) and stereopsis.
Main Methods:
- Retrospective review of 108 children who underwent bimedial rectus recession (BMR) for ET.
- Patients were categorized into three groups based on age at initial surgery: before one year, 1-2 years, and after two years.
- Analysis of preoperative data, including angle of deviation and refractive error, and postoperative outcomes.
Main Results:
- No significant differences in preoperative angle of deviation or refractive error were found across age groups.
- A higher rate of dissociated vertical deviation (DVD) was observed in the group that had surgery before one year old (p=0.03).
- Earlier surgery was associated with a significantly greater risk of requiring additional surgery (p=0.01), but stereopsis rates did not differ significantly among groups.
Conclusions:
- Early surgical alignment of infantile esotropia (ET) does not guarantee high-grade stereoacuity.
- Early intervention may increase the likelihood of developing inferior oblique overaction and dissociated vertical deviation (DVD).
- The timing of initial surgery for ET influences the risk of developing complications and the need for reoperation.
Background/Aim:
Infantile esotropia (ET), entitled as congenital ET, is defined as an alternating, cross-fixational ET that occurs within the first 6 months of life. The aim of this study was to determine the long-term motor and sensory outcomes after surgical correction of patients with infantile ET.
Methods:
Medical records of 108 consecutive children who had bimedial rectus recession (BMR) initially for ET were reviewed retrospectively. The patients were divided into 3 groups: the group I, surgery before one-year old; the group II, surgery between one and two-year old; the group III, surgery after two-year old.
Results:
No significant differences were determined among the groups for preoperative mean angle of deviation and refractive error (p > 0.05, for both). Development rate of dissociated vertical deviation (DVD) was greater (40%) in the group I, and the relationship between the rate of DVD and the timing of the initial surgery was statistically significant (p = 0.03). Risk for additional surgery was significantly greater in patients with a younger mean age at initial surgery (p = 0.01). Although measurable stereopsis rate was higher in the group I (35%, 32.4%, 27.8%, respectively) the difference among the groups was insignificant (p = 0.80).
Conclusion:
Patients with ET have limited potential of high grade stereoacuity despite the early alignment of eyes. Early surgery also has potential effects for the development of both inferior oblique overaction and DVD earlier.
