Journal List > J Korean Ophthalmol Soc > v.55(2) > 1009889

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

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.

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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.
jkos-55-271f1.tif
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.
jkos-55-271f2.tif
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.
jkos-55-271f3.tif
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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