Surgical Outcomes Dependent on the Amount of Hyperopia in Infantile Esotropia

Yu Jeong Kim; Kwang Hoon Shin; Hae Jung Paik

doi:10.3341/JKOS.2016.57.11.1752

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Kim, Shin, and Paik: Surgical Outcomes Dependent on the Amount of Hyperopia in Infantile Esotropia

Original Article

J Korean Ophthalmol Soc 2016;57(11):1752-1758.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/JKOS.2016.57.11.1752

Surgical Outcomes Dependent on the Amount of Hyperopia in Infantile Esotropia

Yu Jeong Kim, MD, Kwang Hoon Shin, 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 21565, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358 E-mail: hjpaik@gilhospital.com

Received 14 April 2016 Revised 20 September 2016 Accepted 25 October 2016

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

In the present study, short-term and long-term surgical outcomes dependent on the amount of hyperopia in patients with infantile esotropia were analyzed.

Methods

In this study, 80 patients with infantile esotropia who underwent both medial rectus recession from 2007 to 2011 and followed up for at least 36 months were retrospectively examined. The patients were divided into two groups according to the degree of hyperopia: ≥ +3.0 D (high hyperopia [HH], n = 59 patients) and < +3.0 D (non-high hyperopia [NH], n = 21 patients). Clinical characteristics analyzed included surgical success rate and dose-response relationship at the 3-month and 3-year post-operative follow-ups.

Results

Initial preoperative alignment (NH: 44.8 ± 10.2 PD, HH: 42.7 ± 11.6 PD, p = 0.450), surgical success rates (NH: 69.5% (41/59), HH: 71.4% (15/21), p = 0.837), under-correction rates (NH: 23.7% (14/59), HH: 9.5% (2/21), p = 0.191) and over-correction rates (NH: 6.8% (4/59), HH: 19.1% (4/21), p = 0.138) were not statistically significantly different between the NH and HH groups. A tendency towards a larger dose-response relationship was observed with HH (NH: 3.9 PD/mm, HH: 4.3 PD/mm) at the 3-month postoperative follow-up, but was not significant (p = 0.105). At the 3-year postoperative follow-up, exodrift was in progress and the dose-response relationship was significantly higher in the HH group than NH group (NH: 3.9 PD/mm, HH: 4.9 PD/mm, p = 0.010). A difference between the groups with amblyopia was observed (NH: 8.5% (5/59), HH: 23.8% (5/21), p = 0.146), although without statistical significance.

Conclusions

The surgical success rate of infantile esotropia was not statistically associated with the amount of hyperopia. There was no statistical association between the dose-response relationship and amount of hyperopia at the postoperative 3-month follow-up, but a statistical association was found in the high dose-response relationship in the HH group at the postoperative 3-year follow-up. Therefore, the conventional amount of recession or muscle resection should be modified in high hyperopic (≥+3.0 D) infantile esotropia, and long-term postoperative follow-up is necessary.

Keywords: Dose-response relationship, High hyperopia, Infantile esotropia, Medial rectus recession, Refractive error

References

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Figure 1.

Post-op angle of deviation – patients with refractive error ≥+5.0 D. Post-op exodrift was more in patients with refractive error ≥+5.0 D. PD = prism diopters; POD = post-op day.

Table 1.

Quantum of medial rectus oculus uterque (MROU) recession for infantile esotropia (ET)

Pre-op angle of ET (PD)	MROU rec (mm)/eye
30	4.0
35	4.5
40	5.0
50	6.0
≥60	6.5

Pre-op = preoperative; PD = prism diopters; rec = recession.

Table 2.

Basic characteristics of patients

	Non high hyperopia (N = 59)	High hyperopia (N = 21)	p-value
Gender (male:female)	24:35	9:12	1.000^†
Age at initial visit (months)	12.3 ± 6.0	11.0 ± 4.0	0.269^*
Age at surgery (months)	21.9 ± 7.4	19.2 ± 5.6	0.097^*
CR (D)	1.19 ± 1.1	3.81 ± 1.6	<0.001^*
Pre-op angle of ET (PD)	42.7 ± 11.6	44.8 ± 10.2	0.450^*
History of preterm delivery (n, %)	12 (20.3)	6 (28.6)	0.544^†
Post-op f/u (months)	49.7 ± 24.9	45.9 ± 20.4	0.490^*

Values are presented as mean ± SD unless otherwise indicated. CR = cycloplegic refraction; D = diopters; Pre-op = preoperative; ET = esotropia; PD = prism diopters; Post-op = postoperative; f/u = follow up.

^* Mann Whitney U-test

^† Fisher's exact test.

Table 3.

Surgical outcomes

	Non high hyperopia (N = 59)	High hyperopia (N = 21)	p-value^*
Surgical success (n, %)	41 (69.5)	15 (71.4)	0.837
Over correction (n, %)	4 (6.8)	4 (19.1)	0.137
Under correction (n, %)	14 (23.7)	2 (9.5)	0.191

Values are presented as n (%) unless otherwise indicated.

^* Fisher's exact test.

Table 4.

Dose-response relationship and amblyopia

	Non high hyperopia (N = 59)	High hyperopia (N = 21)	p-value
D-R relationship at post-op 3 months (PD/mm)	3.9 ± 1.0	4.3 ± 0.9	0.105^*
D-R relationship at post-op 3 years (PD/mm)	3.9 ± 1.0	4.9 ± 1.5	0.010^*
Amblyopia (n, %)	5 (8.5)	5 (23.8)	0.146^†

Values are presented as mean ± SD unless otherwise indicated. D-R = dose-response; post-op = postoperative; PD = prism diopters.

^* Mann Whitney U-test

^† Fisher's exact test.

Table 5.

Short term versus long term dose-response relationship depending on degree of hyperopia (correlation analysis)

	Pearson's R	p-value^*
D-R relationship at post-op 3 months (PD/mm)	0.230	0.040
D-R relationship at post-op 3 years (PD/mm)	0.305	0.007

D-R = dose-response; post-op = postoperative; PD = prism diopters.

^* Pearson's correlation coefficient.

Table 6.

Clinical features of patients with refractive error ≥ +5.0D

	Age at OP (months)	CR (D)	Pre-op angle of deviation (PD)	D-R relationship (PD/mm)	Amblyopia (+/−)	F/u duration (months)
Case I	28	+5.00	35	4.78	+	42
Case II	18	+5.00	45	4.76	–	36
Case III	22	+5.50	45	5.05	–	54
Case IV	24	+5.50	40	5.80	+	41
Case V	16	+9.50	45	6.19	+	87

OP = operation; CR = cycloplegic refraction; D = diopters; Pre-op = preoperative; PD = prism diopters; D-R = dose-response; F/u = follow up.

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