Three-Muscle Surgery for Infantile Esotropia in Children Younger Than Age 2 Years

Abstract

To review the long-term outcome of infants undergoing three-muscle surgery for infantile esotropia. Surgical records of 10 patients with esotropia > or = 55 prism diopters (PD) who underwent three-muscle surgery for large-angle infantile esotropia were reviewed. Outcome measures included over- or undercorrection, need for additional surgery, and amount of deviation at last follow-up. Mean age at initial surgery was 13 months. Mean preoperative deviation was 62.5 PD of esotropia. A single surgery was associated with satisfactory horizontal alignment in only three (30%) patients at last follow-up (mean, 37.1 months; range, 8-70 months). Esotropia was undercorrected in one (10%) and overcorrected in six (60%) patients, all of whom required additional surgery. One patient with satisfactory horizontal alignment required an additional procedure to correct a right hypertropia causing a left face turn. In contrast to older children and adults, three-muscle surgery may be inappropriate for infants with large-angle esotropia due to a large overcorrection rate. This controversy may benefit from a prospective study.