Surgery For Esotropia Research Articles

Orbital surface coil imaging predicts surgical anatomy of medial rectus muscle in consecutive exotropia: a case report

A 51-year-old woman with consecutive exotropia after surgery for esotropia underwent magnetic resonance imaging (MRI) of her orbits by orbital surface coil. Imaging demonstrated an 8.0 mm segment of very thin tissue that spanned the distance from a normal-looking medial rectus muscle proximally to the sclera distally. Surgical treatment revealed anatomic pathology of the medial rectus muscle consistent with spatial relationships of stretched scar and muscle that were predicted by MRI.

Long-Term Results of Bilateral Medial Rectus Muscle Recession in Children with Developmental Delay

ABSTRACTPurpose: To assess the long-term results of a reduced amount of medial rectus recession in children with esotropia and developmental delay.Methods: A retrospective chart analysis of 42 children with developmental delay who had undergone surgery for esotropia during a 20-year period in a large referral center was performed. The pre- and postoperative angle of deviation was calculated for each subject as the mean of distant and near angles measured by a cover test or the Krimsky measurement. Surgical success was categorized as esotropia or exotropia of ≤10 prism diopters (PD). The main outcome measure was a stable surgical result after several years of follow-up.Results: The chart review identified 42 children who met inclusion criteria, with a mean age of 2.9 years (range, 0.8-10 years). The mean angle of esotropia prior to surgery was 44.29 ± 13.9 PD (range 20-80 PD). All patients had bilateral medial rectus muscle recessions, with a mean surgical dosage of 5.04 ± 0.62 mm per muscle, on average 0.66 mm less than the standard amount. The average postoperative follow-up was 4.6 years (median 3.67 years, range 8 months-15 years). Twenty-four children (57%) achieved surgical success, 13 (31%) were undercorrected, and 5 (12%) were overcorrected. Ten of the 18 with an unsuccessful surgical outcome underwent a second procedure. The overall surgical success rate for all patients after all procedures was 71%.Conclusions: The main reason for surgical failure after bilateral medial rectus muscle recession (BMR) in developmentally delayed children remains residual esotropia. However, with time, more patients demonstrated consecutive exotropia. Although it is difficult to achieve a stable long-term ocular alignment in children with developmental delay, satisfactory results may be achieved with additional surgical procedures. The optimal amount of primary recession and whether to perform the surgical schedules according to the Parks tables or to reduce the amount of the recession when operating on children with developmental delay is still debatable.

Spontaneous Regression of Over-elevation in Adduction Following Esotropia Surgery.

To evaluate the course of over-elevation in adduction in patients who had esotropia following correction of horizontal deviation. The review of the medical files identified 28 patients who had esotropia with over-elevation in adduction. Data collected from the patients' full ophthalmological examinations included visual acuity, ocular alignment, duction, versions and sensory tests for binocularity and stereopsis, cycloplegic retinoscopy, and fundus evaluation. Oblique muscle function was graded on a scale of -4 to +4. The primary outcome measure was the amount of improvement in over-elevation in adduction following esotropia surgery. Of the 28 patients (mean age: 53.5 ± 53.7 months), 13 were males and 15 were females. Of these, 22 (78.6%) had infantile esotropia and 6 (21.4%) had partial accommodative esotropia. The mean follow-up was 16.3 ± 7.9 months. All patients underwent bilateral medial rectus recession for correction of esotropia. The mean preoperative inferior oblique overaction was +2.1 ± 0.7 and the final postoperative value was +0.8 ± 0.9 (P < .001). There was a statistically significant decrease in postoperative over-elevation in adduction at all postoperative visits compared to the preoperative value (P < .001 at 3- and 6-month and final visits). Over-elevation in adduction regressed in 42 eyes (80.8%). Of these, 18 eyes (34.6%) completely resolved without any additional surgery to the inferior oblique muscle. Spontaneous regression in over-elevation in adduction was observed after esotropia surgery without additional inferior oblique weakening surgery. This may affect presurgical evaluation of and surgical planning for patients.

Long-term motor and sensory outcomes after surgery for infantile esotropia.

Infantile esotropia (ET), entitled as congenital ET, is defined as an alternating, cross-fixational ET that occurs within the first 6 months of life. The aim of this study was to determine the long-term motor and sensory outcomes after surgical correction of patients with infantile ET. Medical records of 108 consecutive children who had bimedial rectus recession (BMR) initially for ET were reviewed retrospectively. The patients were divided into 3 groups: the group I, surgery before one-year old; the group II, surgery between one and two-year old; the group III, surgery after two-year old. No significant differences were determined among the groups for preoperative mean angle of deviation and refractive error (p > 0.05, for both). Development rate of dissociated vertical deviation (DVD) was greater (40%) in the group I, and the relationship between the rate of DVD and the timing of the initial surgery was statistically significant (p = 0.03). Risk for additional surgery was significantly greater in patients with a younger mean age at initial surgery (p = 0.01). Although measurable stereopsis rate was higher in the group I (35%, 32.4%, 27.8%, respectively) the difference among the groups was insignificant (p = 0.80). Patients with ET have limited potential of high grade stereoacuity despite the early alignment of eyes. Early surgery also has potential effects for the development of both inferior oblique overaction and DVD earlier.

Unilateral Lateral Rectus Muscle Advancement Surgery Based on One-fourth of the Angle of Consecutive Esotropia

To evaluate the efficacy of unilateral lateral rectus muscle advancement surgery based on one-fourth of the angle of consecutive esotropia within 25 prism diopters (PD) occurring after bilateral lateral rectus muscle recession for intermittent exotropia. Medical records of 11 patients who underwent unilateral lateral rectus muscle advancement for consecutive esotropia from 2011 to 2014 and who were observed for at least 6 months after surgery were retrospectively reviewed. The change in angle of deviation from before to after consecutive esotropia surgery, as well as the success rate and surgical effect, were evaluated. Preoperative esodeviation was −19.6 ± 4.7 PD [median − 20.0 PD, interquartile range (IQR) 9.0] at distance and −16.5 ± 7.4 PD [median − 18.0 PD, IQR 17.0] at near. The mean surgical amount of unilateral lateral rectus muscle advancement surgeries, based on one-fourth of the angle of consecutive esotropia, was 4.8 ± 1.1 mm [median 5.0 mm, IQR 2.0]. Of the 11 patients, 10 (91%) recovered to orthotropia or exodeviation within 8 PD. The surgical effects of unilateral lateral rectus muscle advancement were 3.3 ± 0.7 PD/mm [median 3.6 PD/mm, IQR 1.0] after 1 day, 3.7 ± 0.6 PD/mm [median 3.8 PD/mm, IQR 1.0] after 1 week, and 3.8 ± 0.7 PD/mm [median 3.8 PD/mm, IQR 1.5] after 6 months. Unilateral lateral rectus muscle advancement surgery based on one-fourth of the angle of consecutive esotropia within 25 PD was successful in all 11 patients. The surgical effect was significantly greater in unilateral lateral rectus muscle advancement than in primary lateral rectus muscle recession. Reduction in the amount of surgery should be considered carefully in unilateral lateral rectus muscle advancement for consecutive esotropia.

Scleral Perforation During Inferior Rectus Muscle Recession in Congenital Fibrosis of the Extraocular Muscles

Purpose: We report a case of a scleral perforation during inferior rectus recession in congenital fibrosis of extraocular muscles and the management of this perforation with a scleral patch graft. Case summary: A 20-month-old female with bilateral ptosis, absence of elevation and a chin-up position was diagnosed with congenital fibrosis of extraocular muscles. Because severe esotropia in the downward gaze was observed, we first performed esotropia surgery. After 1 year, she underwent a bilateral ptosis correction. We decided to perform bilateral inferior rectus recession due to an abnormal head posture and the absence of elevation. Because the inferior rectus muscles were extremely tight and adhered to the sclera, hooking and isolating these muscles during surgery was difficult. After muscle suture placement, a portion of the sclera that contacted the left inferior rectus was chipped off as this muscle was disinserted with blunt Westcott scissors. A scleral perforation was observed, thus, we placed a scleral patch graft using the donor sclera and finished the bilateral inferior rectus recession. No abnormal findings for the vitreous or retina were detected. At 8 months after surgery, the patient exhibited exotropia of 12 prism diopters in her primary gaze. Her abnormal head posture nearly disappeared. Conclusions: Careful isolation and disinsertion of the muscle from the globe is necessary in the treatment of patients who are expected to exhibit severe adhesions between the muscle and sclera, such as patients with congenital fibrosis of extraocular muscles. J Korean Ophthalmol Soc 2016;57(3):524-527

Immediate postoperative alignment following surgery for esotropia in children compared to adults

1. Mohney BG. Common forms of childhood strabismus in an incidence cohort. Am J Ophthalmol. 2007 Sep;144(3):465-7. 2. Greenberg AE, Mohney BG, Diehl NN, Burke JP. Incidence and types of childhood esotropia: a population-based study. Ophthalmology. 2007 Jan;114(1):170-4. 3. Martinez-Thompson JM, Diehl NN, Holmes JM, et al. Incidence, types, and lifetime risk of adult-onset strabismus. Ophthalmol. 2014; 121(4): 877-82. 4. Dankner SR, Mash AJ, Jampolsky A. Intentional surgical overcorrection of acquired esotropia. Arch Ophthalmol. 1978; 96: 1848-52. 5. Ruttum MS. Initial versus subsequent postoperative motor alignment in intermittent exotropia. J AAPOS. 1997; 1: 88-91. 6. Choi J, Kim SJ, Yu YS. Initial postoperative deviation as a predictor of long-term outcome after surgery for intermittent exotropia. J AAPOS. 2011; 15: 224-229. 7. Raab EL, Parks MM. Recession of the lateral recti: early and late postoperative alignments. Arch Ophthalmol. 1969; 82: 203-8. 8. Scott WE, Keech R, Mash AJ. The postoperative results and stability of exodeviations. Arch Ophthalmol. 1981; 99: 1814-8. 9. McNeer KW. Observations on the surgical correction of childhood intermittent exotropia. Am Orthoptic J. 1987; 37: 135-150. • Strabismus is a common disorder of ocular alignment that affects up to 4% of children and a similar proportion of adults.1-3

Surgical outcome of strabismus

Introduction: Strabismus is encountered daily by paediatric ophthalmologists and orthoptists in their practice.Strabismus and amblyopia affect 5% of the population. The aim of the study was to determine the surgicaloutcome of strabismus.Methods: It was a prospective study conducted at Nepal Eye Hospital from 2010 to 2011 with the samplesize of 40. Patients undergoing strabismus surgery either for esotropia or exotropia were included in the study.Detailed preoperative and postoperative orthoptic evaluation of all the patients was done apart from the anteriorand posterior segment examination and the surgical outcome was assessed.Results: Forty patients of which 52.5% males and 47.5% females with mean age of 21.025 years underwentstrabismus surgery. Manifest divergent squint was present in 61%, manifest convergent squint in 38% andintermittent squint in 5% of patients. 87.5% underwent 2 muscle surgery, 10% underwent 3 muscle surgeryand 2.5% underwent single muscle surgery. Postoperative deviation for near was 0 ???? in 10%, 2-8 ???? in 37.5%and 10-15???? in 27.5%. Similarly, postoperative deviation for distance was 0???? in 22%, 2-8???? in 27% and 10-15????in 22%. Binocular single vision was present in 50% patients preoperatively and 53% patients postoperatively.Conclusion: Though cosmesis has been improved in most of the patients after strabismus surgery, binocularsingle vision and stereopsis improved in very minimal percentage of patients as the surgery was done after theage of visual maturation in most of the cases. This accentuates the need for strabismus surgery within the yearsof cortical plasticitydoi: http://dx.doi.org/10.3126/mjsbh.v12i2.12921

The factors affecting surgical success rate for the patients with congenital esotropia

Objective. To evaluate the factors and preoperative clinical features affecting surgical success rate in patients with congenital esotropia. Method. The medical files of patients who underwent surgery for congenital esotropia between June 2012 and September 2014 were retrospectively reviewed. Data from the patients’ full ophthalmological examination included visual acuity, ocular alignment, duction, versions and sensory tests for binocularity, cycloplegic retinoscopy and fundus evaluation. Presence of previous ambliyopia treatment, fixation preference, cross-fixation, anisometropia >1.5D, ocular motility abnormalities were noted. The relationship of these variables with the surgical success rate was evaluated. Results. A total of 48 patients (25 female,52.1%) were included. The mean age of the patients was 4.4±5.2 years. Successful surgical outcome was achieved in 39 (81.3%). All the patients were followed for 14.1±4.4 months. There was no relation between surgical success and patients’ gender, positive family history, consanguinity, previous ambliyopia treatment, anisometropia, abnormal ocular motility and cross-fixation and mean cycloplegic refraction (p>0,05). However, fixation preference and mean preoperative deviation found to be related with surgical failure (p<0,05). Conclusion. In this study many variables such as epidemiologic characteristics and clinical features of patients were investigated for their possible association with surgical success rate. Only preoperative fixation preference without ambliyopia and mean preoperative deviation were found to be risk factors for the surgical failure in this group of patients with infantile esotropia.

Retrospective review of ocular alignment after large-angle congenital esotropia surgery

Objective: The study’s aims were to evaluate the success of bimedial rectus recession as a primary surgical procedure for patients with congenital esotropia; describe the demographic data of the study group; and compare surgical success with patient age at the time of surgery.Method: A retrospective review of 52 patients with congenital esotropia ≥ 50∆ (prism dioptres) was conducted. All patients underwent bimedial rectus recession and were followed-up postoperatively for a minimum of 6 months.Results: The study period was from January 1992 to September 2003. Fifty-two patients were included in the study group. The pre-operative angle of deviation ranged from 50∆–85∆. Patient ages ranged from 15 months to 22 years, with a mean of 5.3 years and a median of 4 years. The gender distribution was 42% male (n = 20) and 58% female (n = 28). Surgery was successful (within 10∆ of orthophoria) in 77% (n = 40), a partial success (10∆–20∆ from orthophoria) in 17% (n = 9) and a failure (&gt; 20∆ from orthophoria) in 6% (n = 3). No statistically significant relationship was found between surgical success and patient age at the time of surgery.Conclusion: The study confirmed that bilateral medial rectus recession, performed as a primary procedure for patients with large-angle (&gt; 50∆) congenital esotropia, has a high success rate. This finding corresponds with the outcomes of similar international studies.

Surgical outcome of strabismus

&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;&lt;/p&gt; &lt;p&gt;Strabismus is encountered daily by paediatric ophthalmologists and orthoptists in their practice. Strabismus and amblyopia affect 5% of the population. The aim of the study was to determine the surgical outcome of strabismus.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;&lt;/p&gt; &lt;p&gt;It was a prospective study conducted at Nepal Eye Hospital from 2010 to 2011 with the sample size of 40. Patients undergoing strabismus surgery either for esotropia or exotropia were included in the study. Detailed preoperative and postoperative orthoptic evaluation of all the patients was done apart from the anterior and posterior segment examination and the surgical outcome was assessed.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt;&lt;/p&gt; &lt;p&gt;Forty patients of which 52.5% males and 47.5% females with mean age of 21.025 years underwent strabismus surgery. Manifest divergent squint was present in 61%, manifest convergent squint in 38% and intermittent squint in 5% of patients. 87.5% underwent 2 muscle surgery, 10% underwent 3 muscle surgery and 2.5% underwent single muscle surgery. Postoperative deviation for near was 0 ? in 10%, 2-8 ? in 37.5% and 10-15? in 27.5%. Similarly, postoperative deviation for distance was 0? in 22%, 2-8? in 27% and 10-15? in 22%. Binocular single vision was present in 50% patients preoperatively and 53% patients postoperatively.&lt;strong&gt; &amp;nbsp;&lt;/strong&gt;&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt;&lt;/p&gt; &lt;p&gt;Though cosmesis has been improved in most of the patients after strabismus surgery, binocular single vision and stereopsis improved in very minimal percentage of patients as the surgery was done after the age of visual maturation in most of the cases. This accentuates the need for strabismus surgery within the years of cortical plasticity.&lt;/p&gt;

Surgical Outcomes and Prognostic Factors of Consecutive Exotropia

Purpose: In this study we evaluated the prognostic factors by comparing the clinical manifestation of consecutive exotropia after consecutive exotropia surgery. Methods: We performed a retrospective study of 65 patients who had surgery due to consecutive exotropia after esotropia surgery in Yeungnam University Medical Center between July 1988 and December 2013. The type of esotropia, age at diagnosis of esotropia, type of esotropia surgery, age at esotropia surgery, type of consecutive exotropia surgery, age at consecutive exotropia surgery, presence of adduction limitation, presence of amblyopia, and preoperative and postoperative angles of strabismus were analyzed. Results: The mean follow-up time after consecutive exotropia surgery was 5.1 ± 5.2 years and 50 of 65 patients showed successful surgical outcomes at the last follow-up. Cumulative success rate of consecutive exotropia remained stable postoperatively in 68.2% of patients after 7.7 years. When comparing the success group and the recurrent group, the age at consecutive exotropia surgery was significantly younger and mean follow-up time was significantly longer in the recurrent group. The mean interval between consecutive exotropia surgery and recurrence of exotropia was 16.9 months in the recurrent group. The mean angle of strabismus at postoperative 1 week was significantly different between the 2 groups; 0.5 prism diopters (PD) esodeviation in the success group and 4.5 PD exodeviation in recurrent group. Conclusions: Recurrence of consecutive exotropia frequently developed with younger age at consecutive exotropia surgery and exodeviation at postoperative 1 week. Recurrent consecutive exotropia should be observed for an extended period, thus requiring periodic long-term postoperative follow-ups. J Korean Ophthalmol Soc 2015;56(12):1926-1932

BANGERTER FOILS IN THE POSTOPERATIVE MANAGEMENT OF ESOTROPIA

Purpose: To evaluate the application of Bangerter foils in the postoperative management of esotropia Methods: A retrospective study of 200 patients who underwent bimedial recessions for various forms of alternating/alternated esotropia in the period of 2000-2013. In the cases of residual postoperative angle, tendency of recurrence of strabismus and preferred fixation, Bangerter foil was fixed on the corrective glass of the dominant eye- either on the next day of surgery, or on the 10-th postoperative day and was in use for at least 6 months. Results: Bangerter foils were applied in 67(35,1%) under corrected patients with a mean residual angle for near 7,01±3,51∆. Mean residual angle in patients without foils was 3,47±4,06∆ (p<0,001). Statistically significant factors in patients with filters were amblyopia treatment before surgery (p<0,001), anisometropia (p=0,003) and type of esotropia (accommodative vs non accommodative (p<0,001). Within the group without filters there was a significant increase of the residual angle for near on the third (p<0,001) and sixth month (p=0,036), while within the group with foils angle was not significantly changed (p=0,325; p=0,058) with time. In the group with foils no cases with relapse of strabismus and amblyopia were recorded and even a decrease of the postoperative angle was clinically observed in some patients. Conclusion: To our experience Bangerter foils are a reliable tool in the postoperative management of under corrected esotropia.

The slippery slope: early signs of instability after surgery for esotropia

Reoperation rates for strabismus surgery remain high even after initial successful realignment. We studied onset of instability with longitudinal analysis comparing postoperative outcomes of esotropia surgery at 2-4 months versus 1 year.

Factors influencing the development and severity of dissociated vertical deviation in patients with infantile esotropia

To investigate the factors associated with the development and the severity of dissociated vertical deviation (DVD) in patients who underwent surgery for infantile esotropia. The medical records of consecutive patients who underwent surgery from March 1998 to December 2011 for infantile esotropia were reviewed retrospectively. The development, severity, and onset of DVD were assessed. Patients were divided into three groups: spontaneous, latent, and no DVD. The age at the time of the initial surgery, the angle of deviation of esotropia, anisometropia, amblyopia, stereopsis measured at the final visit, and history of prematurity were compared. A total of 90 patients were included. DVD was detected in 52 (58%). Of these, 34 patients demonstrated spontaneous DVDs and 18 showed latent DVDs. In the spontaneous DVD group, 71% underwent surgery after 24 months and 50% had a large angle of esodeviation (>60(Δ)), compared to the latent DVD group, in which 22% underwent later surgery and 11% had large-angle esodeviations (P < 0.001 and P = 0.002, respectively), and the no DVD group, in which 16% underwent later surgery and 13% had large-angle esodeviations (P < 0.001 each). Multivariate logistic regression analysis between groups revealed that later surgery (OR = 8.23; P < 0.001) and large-angle esodeviation (OR = 6.32; P= 0.003) were associated that greater development of spontaneous DVD. Surgical correction for infantile esotropia prior to 24 months of age, especially in caseswitha large amount of esodeviation, decreased the incidence of spontaneous DVD.

Goal-determined metrics to assess outcomes of esotropia surgery

To report outcomes of esotropia surgery with a goal-determined tool. A goal-determined outcomes analysis tool was devised to address a quality improvement initiative at Boston Children's Hospital. Surgeons preoperatively ranked four possible goals for intervention: enhancement of binocular potential, restoration of eye contact (reconstructive), management of diplopia, and resolution of torticollis. Criteria for success were goal specific; the primary outcome measure was surgical success at 2-4 months. Secondary outcomes included appraisal of risk factors and a comparison of outcomes with this methodology versus traditional criteria for success based on motor alignment. No patients were excluded based on diagnosis, systemic and ocular risk factors, or intervention performed. A total of 824 patients underwent esotropia surgery from 2006 to 2012 and returned for evaluation at 2-4 months' follow-up. Of these, 777 had sufficient documentation for inclusion: 372 procedures were performed primarily to improve binocular potential; 238, to restore eye contact; 124, to resolve diplopia; and 43, to remediate torticollis. Excellent (71%) or good (13.7%) results were obtained in 84% of cases. Without associated risk factors, 75% had excellent and 14% had good outcomes. Risk factors were present in 444 (57%). Success diminished with prior strabismus surgery (P = 0.004), preoperative angle ≥50(Δ) (P = 0.002), and surgery before 12 months of age (P = 0.003). Patients having surgery to remediate diplopia had the best outcomes (excellent, 79%; good, 8%). Preoperative ranking of goals allowed demonstration of better results than would have been reported with requirement of "traditional" motor alignment criteria (P = 0.009). Goal-determined methodology can be useful for monitoring outcomes of esotropia surgery in diverse populations.

The relationship of age when motor alignment is achieved and the subsequent development of stereopsis in infantile esotropia

To determine the oldest age beyond which the chance of developing stereopsis is not possible even with excellent motor alignment in patients with infantile esotropia. The medical records of children with infantile esotropia who underwent a single operation and had alignment within 10(Δ) of orthotropia at all follow-up examinations were retrospectively reviewed. Patients were assessed for stereopsis after the age of 48 months. A total of 38 children were included. There was a statistically significant inverse correlation between age at surgery and final stereopsis (r = 0.494, P = 0.002). There was a significant difference at mean age at surgery between patients having stereopsis better than 1000 arcsec and those having no stereopsis (P = 0.002). Post hoc power analysis revealed a value of 85%. Receiver operating characteristic curve analysis revealed that the optimum cut-off value of the age at surgery for predicting stereopsis was 16 months (Youden index = 0.474; area under ROC curve, 0.784; 95% CI: 0.62-0.90; P = 0.0002). Surgery for infantile esotropia is most likely to result in measureable stereopsis if patient age at alignment is not more than 16 months.

Results of Bilateral Medial Rectus Recession for Comitant Esotropia in Patients with Developmental Delay

Purpose: There is paucity of literature on surgical outcomes after strabismus surgery in patients with developmental delay. There is no consensus regarding whether standard surgical tables are applicable to these children. The goal of our study was to determine results of strabismus surgery for esotropia among these children.Methods: Two retrospective cohorts of patients, with developmental delay (excluding Down syndrome) and without developmental delay, who underwent bimedial recession for comitant eso-deviation between January 2005 and January 2011, meeting our criteria, were selected. Amount of surgery performed in these children was compared with standard table. This comparison gave us operated angle of deviation. This operated angle of deviation was expressed as percentage of preoperative angle of deviation to get amount of surgery performed. Response to surgery was defined as percentage of change in angle of deviation after surgery to the operated angle of deviation. Amount of surgery performed, response to surgery, and results were compared between two groups.Results: This study included 25 patients with developmental delay and 53 normal children with comitant esotropia. Age, refractive error, and preoperative angle of deviation were comparable in patients with and without developmental delay. Among patients with developmental delay, on average 72.13% ± 16.08 of angle of deviation was operated; response to surgery gained was 134.06% ± 51.62. In the control group, the average amount of surgery done was 89.08% ± 10.83; response gained was 89.83% ± 22.49. Successful outcome (±10 PD of orthophoria) was noted in 60% patients with developmental delay compared to 73.58% in control group. On average 70.67% ± 17.95 angle of deviation was operated in patients with developmental delay with successful outcome.Conclusion: Surgical outcome in patients with developmental delay is very unpredictable. An exaggerated response to standard amounts of bimedial recession should be anticipated in these patients. Though there was no statistically significant difference, operating for 70.67% ± 17.95 angle of deviation is more likely to be successful.

Consecutive esotropia after surgery for intermittent exotropia: the clinical course and factors associated with the onset

BackgroundTo analyse the incidence and factors associated with the onset of consecutive esotropia after surgery for intermittent exotropia, and to investigate its clinical course.MethodsWe retrospectively reviewed the medical records of...

What to Predict Favorable Long-Term Sensory Outcome after Surgery for Infantile Esotropia?

What to Predict Favorable Long-Term Sensory Outcome after Surgery for Infantile Esotropia?