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Alignment success following medical rectus recessions in normal and delayed children
J D Pickering1, J W Simon, C D Ratliff
1Department of Ophthalmology, Albany Medical College, New York 12203, USA.
Insights
Developmentally delayed children with esotropia have a poorer prognosis after surgery compared to normal children. Adjusting surgical amounts may improve outcomes for delayed children undergoing medial rectus recession.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Developmental delay is often associated with esotropia.
- Previous studies suggest a poorer prognosis for esotropia surgery in developmentally delayed children.
- No direct comparison of surgical outcomes between normal and delayed children has been conducted.
Purpose of the Study:
- To compare the long-term surgical success rates of esotropia correction in normal versus developmentally delayed children.
- To evaluate the impact of developmental delay on outcomes following bilateral medial rectus recession.
Main Methods:
- A retrospective study comparing outcomes in 62 normal children and 29 developmentally delayed children.
- All patients underwent graded bilateral medial rectus recessions for esotropia.
- Success was defined as alignment within 10 prism diopters (PD) of orthophoria.
- Survival analysis using the Mantel-Haenszel statistic was employed.
Main Results:
- Developmentally delayed children demonstrated significantly poorer outcomes (p = .05) over a mean follow-up of 24 months (range 12-120 months).
- An initial higher rate of overcorrections was observed in the delayed group.
- Modifications to surgical technique, specifically more conservative recessions, appeared to improve initial and long-term success in delayed children.
Conclusions:
- Developmentally delayed children have a poorer prognosis following medial rectus recession for esotropia compared to their normal peers.
- A more conservative surgical approach may enhance the success rate and long-term alignment in this patient population.
Abstract:
Others have suggested that developmentally delayed children, who are frequently esotropic, have a poor prognosis following esotropia surgery. To date, no comparison of success rates in normal and delayed children following similar surgery has been made. We compared our long-term results following graded bilateral medial rectus recessions in consecutive normal (n = 62) and delayed (n = 29) children. We defined success as alignment maintained within 10 delta of orthophoria. Survival curves were compared using the Mantel-Haenszel statistic. Delayed children had a significantly poorer outcome (p = .05) throughout follow up, which ranged from 12 to 120 months (mean = 24 months). Early in the period of study, we observed a large proportion of overcorrections among the delayed children. Subsequent modification in the amount of surgery performed appeared to improve the initial and long-term success in these children. We conclude that delayed children do have a poorer prognosis than normal children following medial rectus recession. This prognosis may be improved by more conservative amounts of surgery.