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Surgical alignment prior to six months of age for congenital esotropia
1Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA.
Insights
Early surgical alignment for congenital esotropia (inward turning eyes) before six months shows limited success in achieving refined binocular vision, including stereoacuity.
Area of Science:
- Ophthalmology
- Pediatric Strabismus Surgery
- Neuroscience of Vision
Background:
- Congenital esotropia is a common form of strabismus in infants.
- Early surgical intervention is often recommended to improve alignment and visual outcomes.
- The long-term functional and motor results of very early surgical correction require further investigation.
Purpose of the Study:
- To conduct the first independent, large-scale multicenter study on the motor and functional outcomes of patients with congenital esotropia.
- To analyze results in patients surgically aligned before six months of age.
- To assess outcomes after a minimum follow-up period of four years.
Main Methods:
- A cohort of sixteen patients surgically aligned at an average age of 4.2 months was evaluated.
- Motor and functional outcomes were assessed at an average follow-up of 7.1 years.
- Standardized motor and sensory tests were employed to evaluate visual function and alignment.
Main Results:
- Eleven patients exhibited minimal or no motor misalignment at near point, with preserved binocular fusion and gross stereopsis.
- One patient, aligned at three months, achieved reproducible refined stereoacuity.
- Patients aligned at four or five months did not show superior binocularity compared to those aligned at six months.
Conclusions:
- Achieving excellent binocularity, including refined stereoacuity, remains challenging in congenital esotropia.
- Very early surgical alignment (before six months) does not guarantee superior visual outcomes.
- Refined stereoacuity is a rare achievement for ophthalmologists treating infantile esotropia, even with prompt surgical intervention.
Purpose:
To complete the first independent and largest multicenter outcome investigation to analyze the motor and functional results of a series of patients surgically aligned prior to age 6 months and followed for a minimum of 4 years.
Methods:
Sixteen patients, surgically aligned at an average age of 4.2 months, were examined at an average of 7.1 years to assess their motor and functional outcomes.
Results:
Motor and sensory tests showed 11 patients to have a small or negligible motor misalignment at near point with both binocular fusion and gross stereopsis ability. A single patient aligned by 3 months of age demonstrated reproducible refined stereoacuity on sensory testing. However, the patients who achieved alignment by 4 or 5 months did not demonstrate any better quality of binocularity than that found in a previously studied group of patients aligned at 6 months.
Conclusion:
Binocularity that includes refined stereoacuity remains an elusive target and a rare outcome for an ophthalmologist treating congenital esotropia, despite very early surgical alignment.
