Long-term Surgical Outcomes for Large-angle Infantile Esotropia

• Published in: American journal of ophthalmology Vol. 189; pp. 155 - 159
• Main Authors: Wan, Michael J., Chiu, Hedva, Shah, Ankoor S., Hunter, David G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2018; Elsevier Limited
• Subjects: Age; Botulinum toxin; Botulinum Toxins, Type A - therapeutic use; Child, Preschool; Children & youth; Esotropia - physiopathology; Esotropia - surgery; Female; Hospitals; Humans; Infant; Male; Medical records; Non-Randomized Controlled Trials as Topic; Oculomotor Muscles - physiopathology; Oculomotor Muscles - surgery; Ophthalmologic Surgical Procedures; Ophthalmology; Pediatrics; Retrospective Studies; Success; Surgery; Surgical outcomes; Treatment Outcome; Vision, Binocular - physiology; United States > US; Massachusetts
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2017.11.006

To report the long-term surgical outcomes for a cohort of children with large-angle infantile esotropia.
Multicenter, nonrandomized clinical study.
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).
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.
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.