Infantile Esotropia: Results in the Neurologic Impaired and "Normal" Child at NCMH (Six Years)/DISCUSSION

Abstract

Charts of all infantile esotropes who received their primary surgical procedure at the North Carolina Memorial Hospital, between February 1978 and June 1984 were reviewed. Neurologic problems (general and ocular) were identified in 29 of the 47 patients (61.7%) followed a minimum three months (x = 25.0 ± 2.9 mos). Frequent general neurologic problems were prematurity, hydrocephalus, mental retardation, cerebral palsy, meningomyelocele, intraventricular hemorrhage, and seizures (neonatal and/or postnatal). Abducens nerve palsy was the most common ocular neurologic impairment. Neurologic impaired esotropes were older (x = 31.9 ± 3.8 mos) than the "normal" group (x = 17.0 ± 3.3 mos) at the time of surgery. Recession/resection procedures were performed on 13 (44.8%) of the neurologically impaired and nine (50.0%) of the normal esotropes. Bimedial recessions were employed on 12 (41.4%) of the patients with neurologic problems and seven (38.8%) of the normal esotropes. Unilateral medial recessions and/or inferior oblique recessions were performed on six patients. At last follow-up, orthophoria (± 10Δ) was present in 16 (55.2%) neurologically impaired patients and 15 (83.3%) normal esotropes (p<0.05 by the normal deviate (z) test). Seven (24.1%) neurologically impaired patients had residual esotropia, while consecutive exotropia was present in six (20.7%) patients. Among normal esotropes, residual esotropia was found in one patient and consecutive exotropia in two (11.1%) patients. DVD's occurred in nine patients while four subjects developed a postoperative accommodative component.

Association between Gestational Age, Birth Weight, Parental Age at Childbirth, Mode of Delivery, and Infantile Esotropia

“… 29 Moreover, the risk factors during pregnancy and delivery are related to the prognosis of infantile esotropia, including a higher rate of surgical failure. 30 – 32 These results will be helpful for obstetricians and pediatricians to improve awareness of the association of these risk factors with infantile esotropia and to recommend early eye examinations for high-risk infants. Vision care providers must diagnose infantile esotropia as early as possible and make informed decisions regarding the management of children with this condition.…”

“…Recent literature demonstrated that early surgery, even very early surgery within 6 months of infantile esotropia onset, results in better outcomes in infantile esotropia 29 . Moreover, the risk factors during pregnancy and delivery are related to the prognosis of infantile esotropia, including a higher rate of surgical failure 30–32 . These results will be helpful for obstetricians and pediatricians to improve awareness of the association of these risk factors with infantile esotropia and to recommend early eye examinations for high-risk infants.…”