What to Predict Favorable Long-Term Sensory Outcome after Surgery for Infantile Esotropia?

Jong Hwan Lee; Hae Jung Paik

doi:10.3341/jkos.2014.55.2.271

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Lee and Paik: What to Predict Favorable Long-Term Sensory Outcome after Surgery for Infantile Esotropia?

Original Article

J Korean Ophthalmol Soc 2014;55(2):271-277.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.2.271

What to Predict Favorable Long-Term Sensory Outcome after Surgery for Infantile Esotropia?

Jong Hwan Lee, MD, Hae Jung Paik, MD, PhD

Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea

Address reprint requests to Hae Jung Paik, MD, PhD Department of Ophthalmology, Gachon University Gil Hospital, #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 405-760, Korea, Tel: 82-32-460-3364, Fax: 82-32-460-3358, E-mail: hjpaik@gilhospital.com

Received 8 July 201318 September 2013 Accepted 20 December 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze pre- and post-operative factors associated with favorable long-term sensory outcome after surgical correction for infantile esotropia.

Methods

This study retrospectively examined 40 patients with infantile esotropia who underwent surgery from January 2000 to December 2010. Clinical characteristics analyzed included age at onset, age at surgery, mean preoperative deviation, amblyopia on initial visit, other associated strabismus (Inferior oblique overaction (IOOA), dissociated vertical deviation (DVD), latent nystagmus), initial and subsequent postoperative motor alignment at 1-week and 2-year follow-up, recurrence rate, and stereopsis. Long-term sensory outcome was categorized as favorable (≤400 arcsec) or unfavorable (>400 arcsec).

Results

The mean follow-up period was 92.53 ± 46.46 months. There were 19 patients (47.5%) in the favorable group and 21 (52.5%) in the unfavorable group. There were no statistically significant differences between the groups with respect to age at onset or surgery, presence of amblyopia, and prevalence of IOOA and DVD, latent nystagmus, or initial post-operative alignment at 1-week. There was a tendency towards worse binocularity with larger preoperative angles of esodeviation, but it was not significant. Binocularity was significantly higher among those who had surgery at age ≤24 months than at age >24 months. Orthotropic alignment within ±10 PD at 2-year follow-up was 68.4% in the favorable group and 38.1% in the unfavorable group. Reoperation was performed on 8 patients (38.1%) in the unfavorable group and no patients (0.0%) in the favorable group.

Conclusions

Surgical correction of infantile esotropia within the first 2 years of life and maintenance of orthotropic alignment within ±10 PD without additional surgery with a minimum follow-up of 2 years may be associated with favorable long-term sensory outcome in infantile esotropia.

Keywords: Age at surgery, Binocularity, Infantile esotropia, Postoperative alignment, Reoperation rate

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Figure 1.

Distribution of stereopsis at postoperative 3 years. There were 19 patients (47.5%) in favorable group and 21 (52.5%) in unfavorable group. Favorable group: patients who Titmus stereoacuity of 400 sec of arc or better at postoperative 3 years. Unfavorable group: patients who Titmus stereoacuity worse than 400 sec of arc at postoperative 3 years. n = number.

Figure 2.

Distribution of age at initial surgery between the 2 sensory outcome groups. Sixteen of 27 patients who received surgical correction for infantile esotropia at or before 24 months of age were included in the favorable group, on the other hand, 3 of 13 patients operated after 24 months of age were included in the favorable group (p = 0.046). n = number.

Figure 3.

Distribution of motor alignment at postoperative 2 years between the 2 sensory outcome groups. Of the total 19 patients in the favorable group, 13 patients (68.4%) were orthotropic, 5 patients (26.3%) were remained or recurrent esotropia, and 1 patient (5.3%) showed consecutive exotropia. In the unfavorable group, 8 of total 21 patients (38.1%) were orthotropic, 8 patients (38.1%) were remained or recurrent esotropia, and 5 patients (23.8%) showed consecutive exotropia (p = 0.039). Orthotropia : <±10 PD, remained ET : ≥10 PD of estropia, consecutive XT : ≥10 PD of exotrpia, n = number.

Table 1.

Baseline characteristics of favorable and unfavorable groups in infantile esotropia

Characteristics	Favorable group	Unfavorable group	p-value
Number of patients	19 (47.5%)	21 (52.5%)
Age at onset (months)	3.42 ± 2.89	2.57 ± 2.38	0.334^*
Age at initial visit (months)	13.47 ± 7.71	16.33 ± 11.55	0.735^*
Age at surgery (months)	18.71 ± 8.15	22.41 ± 11.18	0.227^*
Prevalence of amblyopia on initial visit (n)	10 (52.6%)	13 (61.9%)	0.750^†
Preoperative refractive error (Dsph)	+2.10 ± 0.81	+1.93 ± 0.93	0.989^*
Preoperative mean angle of esodeviation (PD)	45.00 ± 8.82	50.96 ± 9.17	0.051^*
Total follow-up period (months)	85.16 ± 49.94	97.81 ± 44.31	0.330^*

Values are presented as mean ± SD; Favorable group: patients who Titmus stereoacuity with 400 sec of arc or better at postoperative 3 years; Unfavorable group: patients who Titmus stereoacuity worse than 400 sec of arc at postoperative 3 years.

SD = standard deviation; Dsph = diopters as spherical equivalent; PD = prism diopters; n = number.

^* Mann Whitney U test

^† Fisher’s exact test.

Table 2.

Prevalence of associated motor dysfunctions in favorable and unfavorable groups

Characteristics		Favorable group	Unfavorable group	p-value
Preoperative	IOOA, n	7 (36.8%)	12 (57.1%)	0.225^*
	DVD, n	0 (0.0%)	4 (19.0%)	0.108^*
	Latent nystagmus, n	0 (0.0%)	2 (9.5%)	0.488^*
Postoperative	IOOA, n	2 (10.5%)	5 (23.8%)	0.412^*
	DVD, n	6 (31.6%)	5 (23.8%)	0.727^*
	Latent nystagmus, n	0 (0.0%)	0 (0.0%)	1.0^*

IOOA = inferior oblique overaction; DVD = dissociated vertical deviation; n = number.

^* Fisher’s exact test.

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