Predictors for Surgical Success in Pediatric Esotropia: A Large Retrospective Cohort Study

To evaluate a large cohort of patients treated by multiple surgeons to identify key predictors of surgical success and evaluate short-term surgical outcomes in pediatric patients with esotropia.

A retrospective chart review was conducted from 2016 to 2023 at a single academic institution, collecting demographic and eye examination data from preoperative and 4- to 12-week postoperative visits. Patients younger than 18 years with esotropia undergoing their first strabismus surgery with either bilateral medial rectus recession (BMRc) or recession and resection (RR) were included. Success was defined as a postoperative distance deviation angle of 10 prism diopters or less. Statistical analysis was performed using R software (The R Project for Statistical Computing).

A total of 730 patients and 13 surgeons were included. The majority (494/730) of children undergoing their first esotropia surgery achieved success, with both BMRc (67.3%) and RR (69.6%) demonstrating high success rates. Surgical success was significantly associated with preoperative deviation angle (P < .05), but not with age, sex, race, ethnicity, insurance type, presence of preoperative gross stereoacuity, interocular difference in logarithm of the minimum angle of resolution (logMAR) visual acuity of 0.2 or better, or Area Deprivation Index national rank (P > .05).

Surgical management of pediatric esotropia is largely successful in the short term both for BMRc and RR. Lower preoperative deviation angles emerged as a key predictor of surgical success.