title: Results of bilateral medial rectus recession for comitant esotropia in patients with developmental delay.
abstract: OBJECTIVE
  There is paucity of literature on surgical outcomes after strabismus surgery in patients with developmental delay. There is no consensus regarding whether standard surgical tables are applicable to these children. The goal of our study was to determine results of strabismus surgery for esotropia among these children.
  
  
  METHODS
  Two retrospective cohorts of patients, with developmental delay (excluding Down syndrome) and without developmental delay, who underwent bimedial recession for comitant eso-deviation between January 2005 and January 2011, meeting our criteria, were selected. Amount of surgery performed in these children was compared with standard table. This comparison gave us operated angle of deviation. This operated angle of deviation was expressed as percentage of preoperative angle of deviation to get amount of surgery performed. Response to surgery was defined as percentage of change in angle of deviation after surgery to the operated angle of deviation. Amount of surgery performed, response to surgery, and results were compared between two groups.
  
  
  RESULTS
  This study included 25 patients with developmental delay and 53 normal children with comitant esotropia. Age, refractive error, and preoperative angle of deviation were comparable in patients with and without developmental delay. Among patients with developmental delay, on average 72.13%±16.08 of angle of deviation was operated; response to surgery gained was 134.06%±51.62. In the control group, the average amount of surgery done was 89.08%±10.83; response gained was 89.83%±22.49. Successful outcome (±10 PD of orthophoria) was noted in 60% patients with developmental delay compared to 73.58% in control group. On average 70.67%±17.95 angle of deviation was operated in patients with developmental delay with successful outcome.
  
  
  CONCLUSIONS
  Surgical outcome in patients with developmental delay is very unpredictable. An exaggerated response to standard amounts of bimedial recession should be anticipated in these patients. Though there was no statistically significant difference, operating for 70.67%±17.95 angle of deviation is more likely to be successful.
authors.affiliation: Department of Pediatric Ophthalmology, Medical Research Foundation , Chennai , India.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Swaminathan
authors.forename: Sanil V
authors.initials: SV
authors.lastname: Shah
authors.forename: Shruti
authors.initials: S
authors.lastname: Mittal
authors.forename: Aarthy
authors.initials: A
authors.lastname: Gunasekaran
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000150:complications*; D004948:Esotropia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology
keywords: Strabismus; developmental delay; esotropia; pediatric; surgical dosage; surgical outcome