title: Three horizontal muscle surgery for large-angle infantile esotropia: validation of a table of amounts of surgery.
abstract: OBJECTIVE
  To validate a table of amounts of three horizontal muscle surgery in patients with large-angle infantile esotropia (≥60 prism dioptres, PD).
  
  
  METHODS
  A prospective interventional case series reporting the postoperative alignment of 51 patients (27 male, 24 female) over a 15-year period was conducted. Surgery amounts were according to a published table developed on a previous patient cohort (n=49), using bilateral medial rectus recession with graded unilateral lateral rectus resection. Kaplan-Meier life-table survival curves were formulated for success to orthotropia (±10 PD) after one and subsequent horizontal muscle surgeries for up to 8 years follow-up.
  
  
  RESULTS
  The median preoperative deviation was 65 PD (range 60-80 PD) and median age at surgery was 11.8 months (range 5.1 months-3.6 years). Surgical success to orthotropia (±10 PD) after one surgery was 100% at 2 months, 95.7% at 6 months, 91.3% at 12 months, 77.8% at 4 years, and 73.6% at 8 years. Postoperative failure requiring further horizontal surgery occurred in 17.6% (residual esotropia 4, consecutive exotropia 5).
  
  
  CONCLUSIONS
  Our second cohort has reproduced the success rate of the previous cohort (77.8% vs 77.1% at 4 years). If the published table of surgical amounts is used, three horizontal muscle surgery in large-angle infantile esotropia (≥60 PD) appears to have a good long-term success rate, and does not lead to the high rates of either residual esotropia or consecutive exotropia reported by others in the literature.
authors.affiliation: Department of Ophthalmology, Royal Children's Hospital, Herston, Queensland, Australia.
authors.forename: J E
authors.initials: JE
authors.lastname: Camuglia
authors.forename: M J
authors.initials: MJ
authors.lastname: Walsh
authors.forename: G A
authors.initials: GA
authors.lastname: Gole
mesh_terms: D002675:Child, Preschool; D004812:Epidemiologic Methods; D004948:Esotropia / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D015203:Reproducibility of Results; D016896:Treatment Outcome