Long-term Surgical Outcomes for Large-angle Infantile Esotropia

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Strabismus Surgery

Background:

• Infantile esotropia is a common form of strabismus in children.
• Large-angle infantile esotropia (≥55 prism diopters) presents significant surgical challenges.
• Long-term outcomes of surgical interventions for this condition require further investigation.

Purpose of the Study:

• To evaluate the long-term surgical outcomes in a cohort of children diagnosed with large-angle infantile esotropia.
• To identify factors influencing the success rate of surgical treatments for infantile esotropia.

Main Methods:

• A multicenter, nonrandomized clinical study was conducted across two tertiary-care pediatric hospitals.
• Eighty-eight children with large-angle infantile esotropia underwent surgical treatment, including bilateral medial rectus muscle recessions, botulinum toxin-augmented surgery, or 3-muscle surgery.
• Outcomes were assessed based on the success rate at final follow-up, defined as postoperative deviation ≤10 prism diopters and no need for retreatment, after a mean follow-up of 40 months.

Main Results:

• The overall success rate was low (23%), with the majority of patients (77%) experiencing treatment failure, primarily due to residual or recurrent esotropia.
• Botulinum toxin-augmented surgery was significantly associated with a higher success rate compared to bilateral medial rectus muscle recessions.
• Among patients requiring retreatment (30%), the average number of procedures was 2.1, with 27% achieving successful alignment at final follow-up.

Conclusions:

• The long-term surgical success rate for large-angle infantile esotropia in this cohort was poor, with high rates of residual or recurrent esotropia.
• Botulinum toxin-augmented surgery demonstrated a more favorable outcome compared to traditional muscle recession techniques.
• Further research into optimizing surgical strategies for complex infantile esotropia is warranted.