Format

Send to

Choose Destination
Am J Ophthalmol. 2018 May;189:155-159. doi: 10.1016/j.ajo.2017.11.006. Epub 2018 Feb 19.

Long-term Surgical Outcomes for Large-angle Infantile Esotropia.

Author information

1
Department of Ophthalmology and Vision Sciences, Hospital for Sick Children and University of Toronto, Toronto, Canada; Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
2
Department of Ophthalmology and Vision Sciences, Hospital for Sick Children and University of Toronto, Toronto, Canada.
3
Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
4
Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: david.hunter@childrens.harvard.edu.

Abstract

PURPOSE:

To report the long-term surgical outcomes for a cohort of children with large-angle infantile esotropia.

DESIGN:

Multicenter, nonrandomized clinical study.

METHODS:

Setting: Two tertiary-care pediatric hospitals.

STUDY POPULATION:

Children with large-angle (≥55 prism diopters) infantile esotropia.

INTERVENTION:

Surgical treatment of infantile esotropia.

MAIN OUTCOME MEASURE:

Success rate at final follow-up (postoperative deviation ≤ 10 prism diopters and no need for retreatment).

RESULTS:

A total of 88 patients with large-angle infantile esotropia were treated during the 13-year study period. Treatment was bilateral medial rectus muscle recessions in 70 patients, botulinum toxin-augmented surgery in 15 patients, and 3-muscle surgery in 3 patients. After a mean follow-up of 40 months, 20 patients (23%) had a successful outcome compared to 68 treatment failures (77%). Of the 68 treatment failures, 59 had residual or recurrent esotropia and 9 had sequential exotropia. On multivariate logistic regression, treatment modality was the only factor significantly associated with a successful outcome. Specifically, patients treated with botulinum toxin-augmented surgery were more likely to have a successful outcome compared to patients treated with bilateral medial rectus muscle recessions. For the 26 patients (30%) who underwent retreatment, the mean number of procedures was 2.1, and 7 (27%) had a deviation of ≤10 prism diopters at final follow-up.

CONCLUSIONS:

The overall success rate for treatment of large-angle infantile esotropia was poor in this cohort, with most failures owing to recurrent or residual esotropia. Botulinum toxin-augmented surgery was associated with a higher success rate at final follow-up.

PMID:
29470973
DOI:
10.1016/j.ajo.2017.11.006

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center