Congenital esotropia surgery in first year of life obtains best results

The best results of surgery for the correction of congenital esotropia are achieved in children aged less than 12 months, according to Malcolm Ing, MD, chairman of the Division of Ophthalmology, University of Hawaii, Honolulu.

The debate about functional results after surgery for congenital esotropia has gone on for decades, Dr. Ing said. In light of this, he conducted a retrospective outcome study of 160 patients over 30 years. Criteria he used were verification of the esotropia, long follow-up, standardized motor and sensory testing, independent assessment without prior knowledge of the patients, alignment a minimum of 6 months after the surgical procedure, and sufficient numbers of patients to conduct a meaningful analysis.

Patients who had been aligned by age 2 were more likely to have fusion and stereopsis compared with those who had undergone surgery past that age (p

"The duration of the misalignment seemed to be even more important than the alignment than the age at alignment per se," he said.

Other noteworthy findings in independent groups of patients indicated that botulinum toxin type A (Botox, Allergan) is less effective than surgical alignment for establishing binocularity. Alignment by a mean age of 4.2 months is not better than alignment at 6 months of age. Finally, most congenital esotropes had progressive increases in the angle of deviation.

"Congenital esotropia is not going to go away," Dr. Ing said. "Waiting to perform surgery is not a good idea because of the increasing angle of deviation. Surgery is superior to [botulinum toxin type A]. There is an increased likelihood of obtaining a functional visual result if surgery is performed within the first year of the patient's life."