title: Trends in surgical correction of strabismus: a 20-year experience, 1990-2009.
abstract: BACKGROUND
  Recent reports and anecdotal observations suggest that strabismus surgery, particularly for infantile esotropia, may be in decline, although a recent population-based study found the incidence to be stable.
  
  
  METHODS
  We analyzed the surgical database of 4,494 primary pediatric strabismus procedures from 1990 through 2009 at Children's Medical Center of Dallas. Linear regression models were used to identify the relationship between the year and the proportion of each surgical category (infantile esotropia, all esotropia, exotropia, and other) using the least-squares approach.
  
  
  RESULTS
  Surgery for infantile esotropia (mean age, 10 months) was performed on 374 patients (mean, 19; range, 11-27/year). Trend analysis demonstrated no significant change in the annual rate of surgery for infantile esotropia (R(2) = 0.004) during the 20-year study period. Additionally, when compared to the annual number of births in Dallas County, no significant change in the incidence of surgically corrected infantile esotropia was noted during the study period (P = 0.25); however, surgery for both infantile esotropia (P = 0.001) and for any esotropia (P = 0.002) declined, while surgery for exotropia increased (P = 0.002) as a proportion of all primary strabismus surgeries.
  
  
  CONCLUSIONS
  The incidence of surgically corrected infantile esotropia has remained stable over a 20-year period. As a proportion of all primary strabismus procedures, surgery for all types of esotropia has decreased and for exotropia has increased.
authors.affiliation: University of Texas Southwestern Medical Center, Department of Ophthalmology, Dallas, Texas 75390-9057, USA. David.Weakley@childrens.com
authors.forename: Erika M P
authors.initials: EM
authors.lastname: Dabes
authors.forename: Erika A
authors.initials: EA
authors.lastname: Dabes
authors.forename: David R
authors.initials: DR
authors.lastname: Weakley
authors.forename: Eileen
authors.initials: E
authors.lastname: Birch
mesh_terms: D002675:Child, Preschool; D016208:Databases, Factual; D004948:Esotropia / Q000453:epidemiology / Q000601:surgery*; D005099:Exotropia / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D016014:Linear Models; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000706:statistics & numerical data / Q000639:trends*; D013781:Texas / Q000453:epidemiology; D013997:Time Factors