Journal List > J Korean Ophthalmol Soc > v.57(11) > 1010453

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

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.

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.
jkos-57-1752f1.tif
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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