title: Essential infantile esotropia with inferior oblique hyperfunction: long term follow-up of 6 muscles approach.
abstract: OBJECTIVE
  To evaluate long term follow-up (10y) of 6 muscle surgical approach in essential infantile esotropia (EIE).
  
  
  METHODS
  A 6 muscle approach to EIE was retrospectively evaluated in patients with inferior oblique (IO) hyperfunction and lateral rectus (LR) pseudoparalysis, who underwent surgery at different ages. Different clinical characters were analyzed pre- and postoperatively, in patients who underwent a 6 muscles approach ≤4 years of age. All patients underwent a multiple muscles approach: bilateral medial recti (MR) recession (4-5 mm), bilateral LR resection (lower than 7 mm) and bilateral IO recession and anteroposition. Of 108 children with preoperative angle ≥+30 prism diopters (PD) and IO hyperfunction were selected from larger cohort of patients (n=213, 103 females and 110 males) after excluding patients with: angle variability, who underwent reoperation and with incomplete follow up. Preoperative assessment and complete orthoptic examination were performed. Follow-up was performed 3mo, 2, 5 and 10y after surgery. Statistical analysis was performes using SAS statistical software package (version 9.1, SAS Institute Inc., Cary, NC, USA).
  
  
  RESULTS
  Ten years follow up data analysis showed the following percentage of orthotropic patients: (0 PD): 3mo, 22.2%; 2y, 16.7%; 5y, 25.0% and 10y, 27.8%. A slight, significant (P<0.01), increase of 2y follow up residual deviation was found when compared to 3mo one. Stationary surgical results is reported during time, with a trend of mean residual deviation reduction (P=0.04).
  
  
  CONCLUSIONS
  Our results confirm the reliability of multiple muscles surgical approach in the treatment of patients affected by EIE with OI hyperfunction.
authors.affiliation: Department of Pediatric Ophthalmology, University of Salerno, Baronissi (SA) 84081, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Magli
authors.affiliation: Department of Pediatric Ophthalmology, University of Salerno, Baronissi (SA) 84081, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Carelli
authors.affiliation: Department of Pediatric Ophthalmology, University of Salerno, Baronissi (SA) 84081, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Chiariello Vecchio
authors.affiliation: GI. MA Eye Center, Naples 80122, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Esposito
authors.affiliation: Department of Ophthalmology, University Federico II, Naples 80131, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Rombetto
authors.affiliation: GI. MA Eye Center, Naples 80122, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Esposito Veneruso
keywords: essential infantile esotropia; follow-up; surgical treatment