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Surgical treatment of congenital esotropia
Insights
Bilateral medial rectus recession surgery for congenital esotropia achieved good alignment in most children. However, early diagnosis and surgery before 12 months did not guarantee stereopsis, suggesting distinct types of congenital esotropia.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Strabismus Research
Background:
- Congenital esotropia is a common misalignment of the eyes present at birth.
- Surgical correction, often bilateral medial rectus recession, aims to improve eye alignment.
- Early intervention is often recommended, but outcomes regarding binocular vision remain a concern.
Purpose of the Study:
- To evaluate the surgical outcomes of bilateral medial rectus recession in children with congenital esotropia.
- To assess the impact of age at diagnosis and surgery on alignment and stereopsis.
- To investigate potential subtypes of congenital esotropia based on fusion potential.
Main Methods:
- Retrospective study of 133 children with congenital esotropia.
- Analysis of surgical technique (augmented or en-bloc bilateral medial rectus recession).
- Assessment of preoperative and postoperative eye alignment, including prism diopters, and stereopsis.
Main Results:
- Good alignment was achieved in a majority of patients post-surgery (within +/- 10 prism diopters for 109/133 at final follow-up).
- Children undergoing surgery after 12 months had a higher rate of requiring second procedures (8/106) compared to those operated on before 12 months (3/27).
- None of the patients with early-onset esotropia (diagnosed before 6 months) who had surgery before 12 months achieved stereopsis, despite adequate alignment.
Conclusions:
- Bilateral medial rectus recession is effective for achieving ocular alignment in congenital esotropia.
- Early surgical intervention before 12 months may not be sufficient to restore stereopsis in all cases.
- The findings suggest the existence of at least two types of congenital esotropia: one with inherent lack of fusion potential and another where fusion is secondarily lost.
Abstract:
We conducted a retrospective study of 133 children (69 boys and 64 girls) who underwent bilateral medial rectus muscle recession (most by the augmented or en-bloc technique) for congenital esotropia. Esotropia was diagnosed before the age of 6 months in 84 patients and after the age of 6 months in the other 49. A total of 27 children underwent surgery before the age of 12 months; of these, three required second procedures. A total of 106 children underwent surgery after the age of 12 months; of these, eight required second procedures. The mean preoperative deviation was 40 prism diopters. Two patients had significant A pattern deviations and 17 had significant V pattern deviations. Six patients had dissociated vertical deviations. Five to 60 days after surgery, 52 patients had no deviation and 99 were within +/- 10 prism diopters of no deviation. Two months after surgery, 67 patients had no deviation and 114 were within +/- 10 prism diopters of no deviation. Final alignments (five months to seven years postoperatively) showed that 51 patients had no deviation and 109 were within +/- 10 prism diopters of no deviation. Despite adequate alignment, none of 13 patients whose esotropia was diagnosed before the age of 6 months, who underwent surgery before the age of 12 months, and who cooperated with testing achieved stereopsis. This suggested that there may be two types of congenital esotropia--one without fusion potential and one in which fusion is possible but lost secondarily because of peripheral esotropic factors.