HIGH-GRADE STEREO ACUITY AFTER EARLY SURGERY FOR CONGENITAL ESOTROPIA

Objective: To evaluate the effectiveness of very early surgery for est ablishing straight eyes and sensory fusion in patients with congenital esotropia. Design: X review of consecutive patients with congenital e so tropia who underwent surgery between 13 and 19 weeks of age. Settin g: A children's hospital with a teaching affiliation. Patients: Seven patients who had surgery between 13 and 19 weeks of age. Intervention: A bilateral medial rectus recession through a fornix incision with re cessions ranging from 5.75 to 6.5 mm in infants younger than 6 months of age. Main Outcome Measures: Sensory fusion as measured by stereo ac uity and Worth four-dot testing and motor alignment within 8 prism dio pters. Results: Five of the seven patients achieved essentially straig ht eyes with tropias of less than 8 prism diopters after one horizonta l surgery. Five patients cooperated with sensory testing, and all show ed stereo acuities that ranged from 400 to 40 seconds of are. Three ch ildren had evidence of high-grade stereo acuity by showing stereopsis on random dot stereograms (Randot, Stereo Optical Co, Chicago, Ill) an d by fusing the Worth four-dot test at distance and near range. Two of the patients with high-grade stereo acuity achieved a stereo acuity o f 40 seconds of are by Titmus testing; however, one had a late reducti on of stereo acuity to 70 seconds of are. Conclusion: Very early surge ry can result in excellent motor alignment and high-grade stereo acuit y in some patients with congenital esotropia.