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Published on: April 3, 2016
Outcome study of surgical alignment before 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 in infants under six months does not consistently improve binocularity or refined stereoacuity, suggesting other factors are crucial for optimal visual outcomes.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Congenital esotropia is a common condition requiring surgical intervention.
- Early surgical alignment in infants under six months is increasingly reported to enhance binocular outcomes.
- The quality of binocular results after early surgery remains a subject of investigation.
Purpose of the Study:
- To evaluate the motor and sensory outcomes of early surgical alignment for congenital esotropia.
- To determine if alignment before six months of age improves binocular function and stereoacuity.
- To assess the long-term results of very early surgical intervention in congenital esotropia.
Main Methods:
- A multicenter independent study analyzed 16 patients younger than six months who underwent surgical alignment.
- Patients were followed for a minimum of four years, with alignment within 10 prism diopters.
- The author examined patients before reviewing clinical records, ensuring objective assessment of motor and sensory function, including fusion and stereopsis.
Main Results:
- Eleven of sixteen patients achieved near-point motor alignment with binocular fusion and gross stereopsis.
- One patient aligned at three months demonstrated refined stereoacuity.
- Alignment at 4-5 months did not yield superior binocularity compared to alignment at six months.
Conclusions:
- Achieving refined stereoacuity in congenital esotropia remains challenging despite very early surgical alignment.
- Optimal binocularity, including refined stereoacuity, is a rare outcome in treated congenital esotropia.
- Further research is needed to identify factors contributing to better binocular outcomes in congenital esotropia.
Background:
Recently, several ophthalmic surgeons have reported surgical alignment with congenital esotropia in patients younger than 6 months of age to improve the quality of the binocular result.
Methods:
The author performed a multicenter independent study of the motor and sensory results obtained in a group of patients younger than 6 months of age. These patients underwent surgical alignment by other investigators to within 10 prism diopters for a minimum of 6 months. The patients had been followed for a minimum of 4 years and were required to have sufficient maturity and normal neurologic status to reliably respond to tests for fusion and stereopsis. The patients were examined and analyzed by the author before any knowledge of the clinical record.
Results:
Sixteen patients underwent surgical alignment at an average age of 4.2 months. Follow-up examination took place at an average age of 7.1 years. 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. One patient, aligned by 3 months of age, demonstrated reproducible refined stereoacuity on sensory testing. The author observed, however, that alignment by 4 or 5 months of age did not result in better quality of binocularity than a previously studied group of patients who underwent alignment at 6 months of age.
Conclusion:
Binocularity that includes refined stereoacuity remains an elusive target and rare outcome for the ophthalmologist treating congenital esotropia, despite the use of very early surgical alignment.
