Effects of Surgical Timing on Surgical Success and Long-term Motor and Sensory Outcomes of Infantile Esotropia

Abstract

Purpose: To investigate the effect of surgical timing on long-term motor and sensory outcomes in patients with infantile esotropia. Methods: The medical records of patients who underwent strabismus surgery for infantile esotropia were reviewed retrospectively. The patients were divided into three groups according to age at the time of surgery: early group (6 to 11 months), late group (12 to 17 months), and very late group (18 to 27 months). The main outcome measures were final alignment, surgical success rate (the angle of deviation at final follow-up of ≤ 10 prism diopters [PD] of esotropia, no exotropia and no need for reoperation), stereoacuity, visual acuity, and the number of reoperations required during the follow-up. Results: A total of 79 patients (44 female, 35 male) met the inclusion criteria. The surgical success rate was 25.9%, 23.1%, and 53.8% in the three groups, respectively ( P = .035). After a mean follow-up of 96 months, the average number of operations per child was 1.7 ± 0.9, 1.6 ± 0.6, and 1.4 ± 0.6 in the three groups, respectively ( P = .020). The measurable stereopsis rate was higher in the early group (37% vs 3.8% and 3.8%, respectively) ( P = .001). The amblyopia rate was similar between groups. Conclusions: The results show that performing surgery later in life in patients with infantile esotropia increases the motor success rate of surgery. In addition, orthophoria is achieved with fewer surgical operations. However, earlier surgery may improve stereopsis. [ J Pediatr Ophthalmol Strabismus . 2020;57(5):319–325.]

Home-based perceptual learning augments high-frequency contrast sensitivity and stereopsis after esotropia surgery: A retrospective cohort study

“…However, numerous studies have reached a consensus that early surgical correction to minimize the duration of constant esotropia could promote probability of developing stereopsis, facilitate treatment of amblyopia, restore normal appearance, and improve general health-related quality of life. 1 , 3 , 7 , 21 , 22 , 23 , 24 …”

“…The selective improvement in medium and high-SF contrast sensitivity aligns with prior work in amblyopia, where PL enhances parvocellular pathway integrity through cortical reorganization. 24 , 29 , 30 However, unlike amblyopia, esotropia is characterized by stronger interocular suppression and earlier onset, which may explain why low SFs (1.5–3 cpd) showed no significant gains. The observed 0.3–0.4 logCS improvements at 12–18 cpd (Cohen’s d = 0.62–0.78) surpass those reported for intermittent exotropia (0.2 logCS), 16 suggesting esotropia’s unique neural adaptability to PL.…”

Home-based perceptual learning augments high-frequency contrast sensitivity and stereopsis after esotropia surgery: A retrospective cohort study

“…However, numerous studies have reached a consensus that early surgical correction to minimize the duration of constant esotropia could promote probability of developing stereopsis, facilitate treatment of amblyopia, restore normal appearance, and improve general health-related quality of life. 1 , 3 , 7 , 21 , 22 , 23 , 24 …”

“…The selective improvement in medium and high-SF contrast sensitivity aligns with prior work in amblyopia, where PL enhances parvocellular pathway integrity through cortical reorganization. 24 , 29 , 30 However, unlike amblyopia, esotropia is characterized by stronger interocular suppression and earlier onset, which may explain why low SFs (1.5–3 cpd) showed no significant gains. The observed 0.3–0.4 logCS improvements at 12–18 cpd (Cohen’s d = 0.62–0.78) surpass those reported for intermittent exotropia (0.2 logCS), 16 suggesting esotropia’s unique neural adaptability to PL.…”

One-Month-Old Rabbits Exhibit a Longer Postoperative Remodeling in Extraocular Muscles Compared to 3-Month-Old Rabbits

“…There is broad consensus that early surgical intervention is essential for promoting the development of binocular vision 33 and cortical function in strabismus, 34 particularly in cases of congenital esotropia. 35 Previous research has explored various factors influencing surgical outcomes, such as binocular function, age of strabismus onset, and refractive status, demonstrating that early surgery often yields satisfactory results.…”

Surgical Outcomes and Factors Related to Their Success of Infantile Esotropia in a Tertiary Hospital: A Retrospective Study

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Home-based perceptual learning augments high-frequency contrast sensitivity and stereopsis after esotropia surgery: A retrospective cohort study

“…However, numerous studies have reached a consensus that early surgical correction to minimize the duration of constant esotropia could promote probability of developing stereopsis, facilitate treatment of amblyopia, restore normal appearance, and improve general health-related quality of life. 1 , 3 , 7 , 21 , 22 , 23 , 24 …”

“…The selective improvement in medium and high-SF contrast sensitivity aligns with prior work in amblyopia, where PL enhances parvocellular pathway integrity through cortical reorganization. 24 , 29 , 30 However, unlike amblyopia, esotropia is characterized by stronger interocular suppression and earlier onset, which may explain why low SFs (1.5–3 cpd) showed no significant gains. The observed 0.3–0.4 logCS improvements at 12–18 cpd (Cohen’s d = 0.62–0.78) surpass those reported for intermittent exotropia (0.2 logCS), 16 suggesting esotropia’s unique neural adaptability to PL.…”

One-Month-Old Rabbits Exhibit a Longer Postoperative Remodeling in Extraocular Muscles Compared to 3-Month-Old Rabbits

“…There is broad consensus that early surgical intervention is essential for promoting the development of binocular vision 33 and cortical function in strabismus, 34 particularly in cases of congenital esotropia. 35 Previous research has explored various factors influencing surgical outcomes, such as binocular function, age of strabismus onset, and refractive status, demonstrating that early surgery often yields satisfactory results.…”

Surgical Outcomes and Factors Related to Their Success of Infantile Esotropia in a Tertiary Hospital: A Retrospective Study

“……”

Home-based perceptual learning augments high-frequency contrast sensitivity and stereopsis after esotropia surgery: A retrospective cohort study

“…However, numerous studies have reached a consensus that early surgical correction to minimize the duration of constant esotropia could promote probability of developing stereopsis, facilitate treatment of amblyopia, restore normal appearance, and improve general health-related quality of life. 1 , 3 , 7 , 21 , 22 , 23 , 24 …”

“…The selective improvement in medium and high-SF contrast sensitivity aligns with prior work in amblyopia, where PL enhances parvocellular pathway integrity through cortical reorganization. 24 , 29 , 30 However, unlike amblyopia, esotropia is characterized by stronger interocular suppression and earlier onset, which may explain why low SFs (1.5–3 cpd) showed no significant gains. The observed 0.3–0.4 logCS improvements at 12–18 cpd (Cohen’s d = 0.62–0.78) surpass those reported for intermittent exotropia (0.2 logCS), 16 suggesting esotropia’s unique neural adaptability to PL.…”

One-Month-Old Rabbits Exhibit a Longer Postoperative Remodeling in Extraocular Muscles Compared to 3-Month-Old Rabbits

“…There is broad consensus that early surgical intervention is essential for promoting the development of binocular vision 33 and cortical function in strabismus, 34 particularly in cases of congenital esotropia. 35 Previous research has explored various factors influencing surgical outcomes, such as binocular function, age of strabismus onset, and refractive status, demonstrating that early surgery often yields satisfactory results.…”

Surgical Outcomes and Factors Related to Their Success of Infantile Esotropia in a Tertiary Hospital: A Retrospective Study

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