Esotropia surgery in children: long term outcome regarding changes in binocular alignment; a study of 956 cases.
OBJECTIVE
To study the correlation between the outcome at 1 month (when the postoperative eye position is at the earliest stabilized), and 4 years after surgery.


METHODS
Retrospective review of medical records.


METHODS
The authors reviewed 956 patients under 15 years of age who underwent unilateral or bilateral recession of the medial rectus muscle during a 22 year period representing the entire practice period of the senior author since the department was founded in 1977. The series comprised 521 cases of congenital/infantile esotropia (manifest before 6 months of age with no accommodative component) and 435 cases of acquired esotropia (manifest after 6 months of age with no accommodative component or with an accommodative component but excluding those with a high AC/A ratio). A consistent surgical plan was employed throughout this period for each condition.


RESULTS
Both types of esotropia showed a slight tendency to become exotropic during the 4 years after surgery. There was no difference in general success with regard to the reconstructive restoration of normal appearance or improvement of appearance between 1 month and 4 years after surgery. Patients with normal retinal correspondence or simultaneous perception achieved better binocular alignments at the 4 year followup than those who did not have such sensory binocular cooperation.


CONCLUSIONS
In infantile and acquired esotropia, it is essential that orthotropia or minimal esotropia be present at 1 month of surgery in order to obtain a binocular alignment within +/- 4 PD of orthotropia 4 years after surgery. It is strongly recommended to avoid overcorrection (consecutive exotropia) at 1 month after surgery for both congenital/infantile and acquired esotropia.
Maruo
T
T
Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, Japan.
Kubota
N
N
Sakaue
T
T
Usui
C
C
D000065:Accommodation, Ocular / Q000502:physiology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004948:Esotropia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005133:Eye Movements / Q000502:physiology*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D015348:Vision, Binocular / Q000502:physiology*