Results of early alignment of congenital esotropia

Objective: To determine the long-term motor and sensory results after early surgical correction of patients with congenital esotropia. Design: Noncomparative interventional case series. Participants: Ten infants with congenital esotropia. Intervention: Patients had bimedial rectus recession between 83 and 159 day s of age; were re-examined in a regular follow-up program, and were retreat ed when required for strabismus, amblyopia, and refractive errors. Main Outcome Measures Final alignment, stereo acuity, variations in vision, alignment, refraction, and number and types of retreatments required durin g the period of observation. Results: All patients were aligned initially with bimedial rectus recession of 8.0 to 10.0 mm measured from the limbus. A total of 11 additional surgi cal procedures were performed on 7 patients to maintain alignment. Four pat ients required hyperopic spectacle correction to maintain alignment, and tw o patients required short periods of patching. Visual acuity was 20/40 or b etter in 19 eyes at the most recent examination, which was between 8.3 and 11.8 years after initial surgery. All patients had final alignment to withi n 10 prism diopters (PD) of orthotropia at either distance or near. Nine of ten patients had dissociated Vertical deviation (DVD), and four of ten pat ients had latent nystagmus. Four patients had measurable stereo acuity at t heir last visit, with two achieving a stereo acuity of 3000 seconds (the Ti tmus fly), one 400 seconds, and one 140 seconds. Conclusion: Surgical alignment of congenital esotropia can be achieved in t he 4-month-old with bimedial rectus recession, but this does not ensure con tinued alignment. At least one additional surgical procedure is required on average to maintain alignment in the first 10 years after initial successf ul surgery. These patients can also be expected to have one or more of the following: DVD, latent nystagmus, refractive component, or latent strabismu s. Regardless of outcome, patients with congenital esotropia have optokinet ic asymmetry. Attainment of stereo acuity, including high-grade stereo acui ty, may be enhanced by attainment of orthotropia or small-angle esotropia b ut is likely to be ultimately dependent on constitutional factors rather th an age of alignment.