Michael J Wan1, Hedva Chiu2, Ankoor S Shah3, David G Hunter4. 1. Department of Ophthalmology and Vision Sciences, Hospital for Sick Children and University of Toronto, Toronto, Canada; Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. 2. Department of Ophthalmology and Vision Sciences, Hospital for Sick Children and University of Toronto, Toronto, Canada. 3. Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. 4. Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: david.hunter@childrens.harvard.edu.
Abstract
PURPOSE: To report the long-term surgical outcomes for a cohort of children with large-angle infantile esotropia. DESIGN: Multicenter, nonrandomized clinical study. METHODS: Setting: Two tertiary-care pediatric hospitals. STUDY POPULATION: Children with large-angle (≥55 prism diopters) infantile esotropia. INTERVENTION: Surgical treatment of infantile esotropia. MAIN OUTCOME MEASURE: Success rate at final follow-up (postoperative deviation ≤ 10 prism diopters and no need for retreatment). RESULTS: A total of 88 patients with large-angle infantile esotropia were treated during the 13-year study period. Treatment was bilateral medial rectus muscle recessions in 70 patients, botulinum toxin-augmented surgery in 15 patients, and 3-muscle surgery in 3 patients. After a mean follow-up of 40 months, 20 patients (23%) had a successful outcome compared to 68 treatment failures (77%). Of the 68 treatment failures, 59 had residual or recurrent esotropia and 9 had sequential exotropia. On multivariate logistic regression, treatment modality was the only factor significantly associated with a successful outcome. Specifically, patients treated with botulinum toxin-augmented surgery were more likely to have a successful outcome compared to patients treated with bilateral medial rectus muscle recessions. For the 26 patients (30%) who underwent retreatment, the mean number of procedures was 2.1, and 7 (27%) had a deviation of ≤10 prism diopters at final follow-up. CONCLUSIONS: The overall success rate for treatment of large-angle infantile esotropia was poor in this cohort, with most failures owing to recurrent or residual esotropia. Botulinum toxin-augmented surgery was associated with a higher success rate at final follow-up.
PURPOSE: To report the long-term surgical outcomes for a cohort of children with large-angle infantile esotropia. DESIGN: Multicenter, nonrandomized clinical study. METHODS: Setting: Two tertiary-care pediatric hospitals. STUDY POPULATION: Children with large-angle (≥55 prism diopters) infantile esotropia. INTERVENTION: Surgical treatment of infantile esotropia. MAIN OUTCOME MEASURE: Success rate at final follow-up (postoperative deviation ≤ 10 prism diopters and no need for retreatment). RESULTS: A total of 88 patients with large-angle infantile esotropia were treated during the 13-year study period. Treatment was bilateral medial rectus muscle recessions in 70 patients, botulinum toxin-augmented surgery in 15 patients, and 3-muscle surgery in 3 patients. After a mean follow-up of 40 months, 20 patients (23%) had a successful outcome compared to 68 treatment failures (77%). Of the 68 treatment failures, 59 had residual or recurrent esotropia and 9 had sequential exotropia. On multivariate logistic regression, treatment modality was the only factor significantly associated with a successful outcome. Specifically, patients treated with botulinum toxin-augmented surgery were more likely to have a successful outcome compared to patients treated with bilateral medial rectus muscle recessions. For the 26 patients (30%) who underwent retreatment, the mean number of procedures was 2.1, and 7 (27%) had a deviation of ≤10 prism diopters at final follow-up. CONCLUSIONS: The overall success rate for treatment of large-angle infantile esotropia was poor in this cohort, with most failures owing to recurrent or residual esotropia. Botulinum toxin-augmented surgery was associated with a higher success rate at final follow-up.
Authors: Stéphane Abramowicz; Philippine Delvaulx; Martina Maria Delle Fave; Pauline Le Roux; Déborah Buisseret; Lavinia Postolache Journal: Case Rep Ophthalmol Date: 2022-04-22