title: The Effect of Achieving Immediate Target Angle on Success of Strabismus Surgery in Children.
abstract: OBJECTIVE
  To determine if achieving the ideal postoperative target range increases the long-term success of pediatric strabismus surgery.
  
  
  METHODS
  Interventional case series.
  
  
  METHODS
  Children below 12 years old with horizontal strabismus who underwent surgical correction by recession, resection, advancement, or a combination of both between 1996 and 2011 were included. Alignment was measured within 1 week and at a minimum of 6 months after surgery. The ideal postoperative target range was defined as 0-8 prism diopters (PD) of esotropia in exotropic patients and within 4 PD of orthotropia in esotropic patients measured within 1 week after the surgery. Success was defined as a measurement within 10 PD of orthotropia at the latest postoperative visit. The main outcome measures were surgical success rate and the factors affecting it.
  
  
  RESULTS
  We included 352 patients with mean follow-up of 18 months. Overall, patients within the target range had a higher success rate than those outside it (75.6% vs 57% P = .0004). This was highly significant for exotropia (P = .0002) but not for esotropia (P = .4). Multiple regression analysis revealed that being within target range was the strongest predictor of long-term success (odds ratio [OR] = 2.3, range 1.4-3.7). Overall, surgeries on patients with esotropia were more likely to be successful than on those with exotropia (OR = 1.9, range 1.2-3), and premature patients had poorer outcomes (OR = 0.2, range 0.1-0.8).
  
  
  CONCLUSIONS
  Achieving the ideal target range within 1 week after surgery is associated with a high rate of long-term success in exotropia surgery in children.
authors.affiliation: Department of Ophthalmology & Vision Sciences, Hospital for Sick Children, Toronto, Canada.
authors.forename: Paulita Pamela
authors.initials: PP
authors.lastname: Astudillo
authors.affiliation: Department of Ophthalmology & Vision Sciences, Hospital for Sick Children, Toronto, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Cotesta
authors.affiliation: Department of Ophthalmology & Vision Sciences, Hospital for Sick Children, Toronto, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schofield
authors.affiliation: Department of Ophthalmology & Vision Sciences, Hospital for Sick Children, Toronto, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kraft
authors.affiliation: Department of Ophthalmology & Vision Sciences, Hospital for Sick Children, Toronto, Canada. Electronic address: kamiar.mireskandari@sickkids.ca.
authors.forename: Kamiar
authors.initials: K
authors.lastname: Mireskandari
mesh_terms: D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D011184:Postoperative Period; D012189:Retrospective Studies; D013285:Strabismus / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology*; D014792:Visual Acuity