Pediatric Ophthalmology Publications
Long-term surgical outcomes for large-angle, infantile esotropia. Am J Ophthalmol 2018;Abstract.
PURPOSE: To report the long-term surgical outcomes for a cohort of children with large-angle, infantile esotropia. DESIGN: Multicenter, non-randomized clinical study METHODS: SETTING: Two tertiary-care pediatric hospitals. STUDY POPULATION: 88 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 three-muscle surgery in 3 patients. After a mean follow-up of 40 months, 20 (23%) patients had a successful outcome compared to 68 (77%) treatment failures. Of the 68 treatment failures, 59 had residual or recurrent esotropia compared to 9 with 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 due to recurrent or residual esotropia. Botulinum toxin-augmented surgery was associated with a higher success rate at final follow-up.