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  • Title: Esotropia surgery in children: long term outcome regarding changes in binocular alignment; a study of 956 cases.
    Author: Maruo T, Kubota N, Sakaue T, Usui C.
    Journal: Binocul Vis Strabismus Q; 2000; 15(3):213-20. PubMed ID: 10960224.
    Abstract:
    PURPOSE: To study the correlation between the outcome at 1 month (when the postoperative eye position is at the earliest stabilized), and 4 years after surgery. METHOD: Retrospective review of medical records. CASES: The authors reviewed 956 patients under 15 years of age who underwent unilateral or bilateral recession of the medial rectus muscle during a 22 year period representing the entire practice period of the senior author since the department was founded in 1977. The series comprised 521 cases of congenital/infantile esotropia (manifest before 6 months of age with no accommodative component) and 435 cases of acquired esotropia (manifest after 6 months of age with no accommodative component or with an accommodative component but excluding those with a high AC/A ratio). A consistent surgical plan was employed throughout this period for each condition. RESULTS: Both types of esotropia showed a slight tendency to become exotropic during the 4 years after surgery. There was no difference in general success with regard to the reconstructive restoration of normal appearance or improvement of appearance between 1 month and 4 years after surgery. Patients with normal retinal correspondence or simultaneous perception achieved better binocular alignments at the 4 year followup than those who did not have such sensory binocular cooperation. CONCLUSIONS: In infantile and acquired esotropia, it is essential that orthotropia or minimal esotropia be present at 1 month of surgery in order to obtain a binocular alignment within +/- 4 PD of orthotropia 4 years after surgery. It is strongly recommended to avoid overcorrection (consecutive exotropia) at 1 month after surgery for both congenital/infantile and acquired esotropia.
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