Long-term motor and sensory outcomes after surgery for infantile esotropia

  • Halil Ibrahim Altınsoy Department of Pediatric Ophthalmology and Strabismus, World Eye Hospital, Ankara, Turkey
  • Gokcen Gokce Department of Ophthalmology, Kayseri Military Hospital, Kayseri, Turkey
  • Osman Melih Ceylan Department of Ophthalmology, Ardahan Military Hospital, Ardahan, Turkey
  • Fatih Mehmet Mutlu Department of Pediatric Ophthalmology and Strabismus, Gulhane Military Medical Academy, Ankara, Turkey
Keywords: esotropia, infants, Infant, child, preschool, ophthalmologic surgical procedures, treatment outcome,

Abstract


Background/Aim. Infantile esotropia (ET), entitled as congenital ET, is defined as an alternating, cross-fixational ET that occurs within the first 6 months of life. The aim of this study was to determine the long-term motor and sensory outcomes after surgical correction of patients with infantile ET. Methods. Medical records of 108 consecutive children who had bimedial rectus recession (BMR) initially for ET were reviewed retrospectively. The patients were divided into 3 groups: the group I, surgery before one-year old; the group II, surgery between one and two-year old; the group III, surgery after two-year old. Results. No significant differences were determined among the groups for preoperative mean angle of deviation and refractive error (p > 0.05, for both). Development rate of dissociated vertical deviation (DVD) was greater (40%) in the group I, and the relationship between the rate of DVD and the timing of the initial surgery was statistically significant (p = 0.03). Risk for additional surgery was significantly greater in patients with a younger mean age at initial surgery (p = 0.01). Although measurable stereopsis rate was higher in the group I (35%, 32.4%, 27.8%, respectively) the difference among the groups was insignificant (p = 0.80). Conclusion. Patients with ET have limited potential of high grade stereoacuity despite the early alignment of eyes. Early surgery also has potential effects for the development of both inferior oblique overaction and DVD earlier.

Author Biography

Gokcen Gokce, Department of Ophthalmology, Kayseri Military Hospital, Kayseri, Turkey
M.D Military Ophthalmologist

References

Helveston EM, Neely DF, Stidham D, Wallace DK, Plager DA, Sprunger DT. Results of early alignment of congenital eso-tropia11The authors have no proprietary interest in the prod-ucts or techniques described in this article. Ophthalmology 1999; 106(9): 1716−26.

Mocan MC, Azar N. Surgical Timing for Infantile Esotropia. Int Ophthalmol Clin 2005; 45(4): 83−95.

Birch EE, Fawcett SL, Stager DR. Risk factors for the develop-ment of accommodative esotropia following treatment for in-fantile esotropia. J AAPOS 2002; 6(3): 174−81.

Ing MR. The timing of surgical alignment for congenital (infan-tile) esotropia. J Pediatr Ophthalmol Strabismus 1999; 36(2): 61−8; quiz 85−6.

Birch EE, Wang J. Stereoacuity outcomes after treatment of in-fantile and accommodative esotropia. Optom Vis Sci 2009; 86(6): 647−52.

Hutcheson KA. Childhood esotropia. Curr Opin Ophthalmol 2004; 15(5): 444−8.

Meyer K, Breitschwerdt H, Kolling GH, Simonsz HJ. The Early vs Late Infantile Strabismus Surgery Study: do sources for bias exist in this non-randomised trial. Br J Ophthalmol 1998; 82(8): 934−8.

Tran HM, Mims JL 3rd, Wood RC. A new dose-response curve for bilateral medial rectus recessions for infantile esotropia. J AAPOS 2002; 6(2): 112−9.

Shon MA, Hahm KH, Han SH, Hwang JM. Spontaneous resolu-tion of infantile esotropia. J AAPOS 2001; 5(1): 44−7.

Birch E, Stager D, Wright K, Beck R. The natural history of infantile esotropia during the first six months of life. J AAPOS 1998; 2(6): 325−8.

Nixon RB, Helveston EM, Miller K, Archer SM, Ellis FD. Inci-dence of strabismus in neonates. Am J Ophthalmol 1985; 100(6): 798−801.

Birch EE, Stager DR. Long-term motor and sensory outcomes after early surgery for infantile esotropia. J AAPOS 2006; 10(5): 409−13.

Christiansen SP, Chandler DL, Holmes JM, Arnold RW, Birch E, Dagi LR, et al. Instability of ocular alignment in childhood eso-tropia. Ophthalmology 2008; 115(12): 2266−74.

Wright KW, Edelman PM, McVey JH, Terry AP, Lin M. High-grade stereo acuity after early surgery for congenital esotropia. Arch Ophthalmol 1994; 112(7): 913−9.

Birch EE, Stager DR, Everett ME. Random dot stereoacuity fol-lowing surgical correction of infantile esotropia. J Pediatr Ophthalmol Strabismus 1995; 32(4): 231−5.

Stager DR, Weakley DR, Everett M, Birch EE. Delayed consecu-tive exotropia following 7-millimeter bilateral medial rectus re-cession for congenital esotropia. J Pediatr Ophthalmol Stra-bismus 1994; 31(3): 147−50.

Ceylan OM, Gokce G, Mutlu FM, Uludag HA, Turk A, Altinsoy HI. Consecutive exotropia: risk factor analysis and manage-ment outcomes. Eur J Ophthalmol 2014; 24(2): 153−8.

Donaldson MJ, Forrest MP, Gole GA. The surgical management of consecutive exotropia. J AAPOS 2004; 8(3): 230−6.

Ganesh A, Pirouznia S, Ganguly SS, Fagerholm P, Lithander J. Con-secutive exotropia after surgical treatment of childhood eso-tropia: a 40-year follow-up study. Acta Ophthalmol 2011; 89(7): 691−5.

Birch EE, Gwiazda J, Held R. Stereoacuity development for crossed and uncrossed disparities in human infants. Vision Res 1982; 22(5): 507−13.

Simonsz HJ, Kolling GH, Unnebrink K. Final Report of the Early vs. Late Infantile Strabismus Surgery Study (ELISSS), a Con-trolled, Prospective, Multicenter Study. Strabismus 2005; 13(4): 169−99.

Neely DE, Helveston EM, Thuente DD, Plager DA. Relationship of dissociated vertical deviation and the timing of initial surgery for congenital esotropia. Ophthalmology 2001; 108(3): 487−90.

Arslan U, Atilla H, Erkam N. Dissociated vertical deviation and its relationship with time and type of surgery in infantile esotropia. Br J Ophthalmol 2010; 94(6): 740−2.

Castro PD, Pedroso A, Hernández L, Naranjo RM, Méndez TJ, Arias A. Results of surgery for congenital esotropia. MEDICC Rev 2011; 13(1): 18−22.

Eustis HS, Nussdorf JD. Inferior oblique overaction in infantile esotropia: fundus extorsion as a predictive sign. J Pediatr Ophthalmol Strabismus 1996; 33(2): 85−8.

Published
2017/03/07
Section
Original Paper