Long-term motor and sensory outcomes after early surgery for infantile esotropia.
OBJECTIVE
The proper timing of surgery for infantile esotropia remains controversial. Early surgery may yield better sensory outcomes whereas later surgery may result in better alignment. Several recent studies reported promising sensory outcomes in small groups of children that underwent surgery by 6 months of age. Here, we present motor and sensory outcomes of a cohort of 50 consecutive children enrolled in a prospective study who had surgery by 6 months of age and were followed for 4-17 years.


METHODS
Angle of deviation, subsequent surgeries, treatment with spectacles, amblyopia, fusion, and stereopsis were evaluated during follow-up. Outcomes from the early surgery group were compared with a concurrently recruited cohort who had surgery at 7-12 months (n=78).


RESULTS
On the initial visit, both cohorts had the same median angle of deviation (45(Delta)) and similar refractive error; the median angle of deviation increased by the final preop visit (55(Delta)). Postoperatively, both cohorts had alignment within 6(Delta) in 83-94% of cases on all visits. Both cohorts had similar rates of additional surgery, and 44-48% wore hyperopic correction postoperatively. Compared with the 7- to 12-month cohort, more children in the early-surgery cohort had peripheral fusion (78% vs 61%; p < 0.02), central fusion (15% vs 2%; p < 0.01), Randot stereopsis (38% vs 16%; p < 0.003), and Randot stereoacuity of 200 seconds or better (20% vs 9%; p < 0.05).


CONCLUSIONS
Early surgery was associated with a higher prevalence of fusion and stereopsis, without adverse motor outcomes.
Birch
Eileen E
EE
Retina Foundation of the Southwest, Dallas, Texas 75231, USA. ebirch@retinafoundation.org
Stager
David R
DR
D003867:Depth Perception / Q000502:physiology*; D004948:Esotropia / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology*; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology*