The relationship between preoperative alignment stability and postoperative motor outcomes in children with esotropia

A Novel Method Ensuring an Immediate Target Angle After Horizontal Strabismus Surgery in Children

Purpose

Pediatric strabismus surgery has low success rates and high reoperation rates because of difficult alignment measurements and the nature of different strabismus types. Furthermore, adjustable sutures are not easily employed in children on an OPD basis.

Methods

This was a retrospective comparative case study of children less than 12 years old who underwent strabismus surgery and were followed up at least 6 months postoperatively. We proposed a novel method that combines adjustable sutures and corneal light reflexes in regular strabismus surgery to improve surgical results. Efficacy and safety were evaluated and compared with those in a regular fixed-suture group.

Results

In total, 128 children (88: exotropia and 41: esotropia) in the novel method group (Group 1) and 109 (71: exotropia and 38: esotropia) in the regular fixed-suture group (Group 2) were enrolled. The primary outcome was the immediate target angle (for esotropia within 4 PD of orthotropia and exotropia within 8 PD of esotropia within the first week postoperatively); the secondary outcome was success at the 6-month visit (angle of deviation < 10 PD). Consequently, there was a significantly higher proportion of achieving the immediate target range and success rate in both exotropic and esotropic patients in Group 1 than in Group 2. A significantly lower reoperation rate was also demonstrated in Group 1. No complications were noted in either group.

Conclusions: The novel method enabled a higher proportion of subjects to achieve an immediate target range and success rate and a lower chance of reoperation among both esotropic and exotropic patients.

Timing of surgery in essential infantile esotropia - What more do we know since the turn of the century?

This review summarizes the results and interpretations of studies pertaining to the long-standing debate regarding the timing of surgery in infantile esotropia, more recently referred to as essential infantile esotropia. A systematic search of studies from the year 2000 onward pertaining to the timing of surgery in infantile esotropia as listed in PubMed, Google Scholar, and the Cochrane database was performed. Appropriate cross-references from the articles were also included. Data collected included demographics, presentation, time of surgery, complications, and outcomes. Very early surgery, that is, within 6 months of the onset of infantile esotropia, offers significant advantages in terms of the quality of stereopsis and binocular vision as well as promoting the development of cortical visual processing, thereby benefiting cortical development in human infants. However, the postoperative alignment was not found to be significantly different in the very early, early, or late surgery groups. The reduction in the incidence of manifest dissociated vertical deviation postoperatively in the very early surgery group also showed measurable benefits. The results of this recent literature review demonstrated that very early surgery, within 6 months of misalignment, showed demonstrable benefits in essential infantile esotropia.

Infantile Esoropia: Management results and prognostic factors

BACKGROUND

Infantile esotropia is characterized by a significant deviation angle and a marked sensory perversion. Although the motor surgical results are satisfactory, the sensory results remain disappointing.

AIM

Our work aims to describe the methods of surgical management, its motor and sensory results as well as its prognostic factors.

METHODS

Retrospective study of 68 cases of infantile esotropia. All patients underwent a complete ophthalmologic examination and sensorimotor assessment. They were operated on, under general anesthesia, by the same surgeon. We assessed the motor and sensory results. The prognostic factors studied were age of onset, treatment delay, amblyopia severity, strabismus deviation angle, and presence of a vertical element.

RESULTS

The mean minimum angle of deflection was 38.6 ± 13.2D. Inferior oblique muscle hyper action was noted in 73.5% and a dissociated vertical deviation in 5.8%. Bilateral medial rectus muscle recession was the most performed surgery (60.2% of cases). The overall success rate was 94.11%. No patient acquired stereoscopic vision. Multivariate logistic regression analysis showed that preoperative nail (p = 0.007), immediate postoperative outcome (p <0.001) and surgical dosage (p = 0.009) were associated with long-term motor success.

CONCLUSION

The motor results of early esotropia surgery are generally satisfactory; the sensory results are often disappointing. Detecting poor prognostic factors improves operative results.

Factors affecting the motor outcome after corrective surgery for acquired comitant esotropia

PURPOSE

To determine the possible predictors of the motor outcome after corrective surgery for acquired comitant esotropia.

METHODS

The study included 40 patients with acquired comitant esotropia. After evaluation of the visual, sensory, and motor status; cycloplegic refraction; fundus examination; and spectacle prescription, all patients underwent corrective strabismus surgery. A successful motor outcome was defined as 0 to 10 prism diopters of horizontal tropia. Statistical analysis of the results was done using the chi-square tests.

RESULTS

At the sixth postoperative month, 90% achieved a successful motor outcome, while 2.5% had a consecutive exotropia >10 prism diopters, and 7.5% had a residual esotropia >10 prism diopters. A statistically significant relationship existed between the motor outcome and the following: preoperative results of the Worth four-dot test at 6 m (p = .011) and 0.33 m (p = .009), preoperative distant (p = .016) and near (p = .017) angles of esotropia with glasses, postoperative near angles of deviation at 1 week (p = .005), 1 month (p < .001), 6 weeks (p < .001), 3 months (p = .001), and 6 months (p < .001) following surgery, postoperative distant angles of deviation at 6 weeks (p < .001) and 3 months (p = .03) following surgery, 6 week (p = .01) and 6 month (p = .036) postoperative results of the Worth four-dot test at 0.33 m, and the 6-month postoperative sensory outcome (p = .006).

CONCLUSION

Preoperative and postoperative sensory and motor functions are predictors of the 6-month postoperative motor outcome.

Surgery for infantile esotropia: is timing everything?

Infantile esotropia affects binocular alignment and development of binocular vision. Delayed correction may lead to loss of stereopsis. Waiting for the angle of deviation to stabilise prior to surgery does not impact overall postoperative outcomes greatly. Early surgical intervention produces better outcomes in terms of sensory and motor development, binocular vision and stereoacuity. The period of misalignment has the greatest effect on postoperative outcome therefore early surgery is recommended.