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Best age for surgery for infantile esotropia: Lessons from the early vs. late infantile strabismus surgery study - Zurich Open Repository and Archive


Simonsz, H J; Kolling, G H (2010). Best age for surgery for infantile esotropia: Lessons from the early vs. late infantile strabismus surgery study. In: Lorenz, B. Pediatric Ophthalmology, Neuro-Ophthalmology, Genetics / Strabismus - New Concepts in Pathophysiology, Diagnosis, and Treatment. Heidelberg: Springer, 135-151.

Abstract

The result of surgery for infantile esotropia (IE) can be described by the following outcome parameters: (1) the binocular vision conserved or regained by early surgery, (2) the postoperative angle of strabismus and the long-term stability of alignment, and (3) the number of operations needed to reach these goals or the chance of spontaneous reduction of the strabismus into a microstrabismus without surgery. To judge the best age for surgery in a specific child with IE, the expected outcome of surgery should be estimated according to these parameters.

There have been no studies with prospectively assigned early- and late-surgery groups and an evaluation according to intention-to-treat, other than the Early vs. Late Infantile Strabismus Surgery Study (ELISSS). The primary outcome of that study was that 13.5% of those operated at approximately 20 months of age against 3.9% (P = 0.001) of those operated at approximately 49 months recognized the Titmus Housefly at the age of 6 years; there was no difference in stereop-sis beyond Titmus Housefly.

Reoperation rates were 28.7% in the early and 24.6% in the late group. 8.2% of the children scheduled for early surgery and 20.1% of the children scheduled for late surgery had not been operated at the age of 6 years; most developed a microstrabismus. Esotropia less than 14° at baseline at approximately 11 months of age had not been operated at the age of 6 years in 35% of the cases. Hypermetropia around spher. + 4 increased the likelihood of regression without surgery, underscoring the need of full refractive correction.

Findings of substantially finer stereopsis after very early surgery await confirmation in a randomized controlled trial.

Abstract

The result of surgery for infantile esotropia (IE) can be described by the following outcome parameters: (1) the binocular vision conserved or regained by early surgery, (2) the postoperative angle of strabismus and the long-term stability of alignment, and (3) the number of operations needed to reach these goals or the chance of spontaneous reduction of the strabismus into a microstrabismus without surgery. To judge the best age for surgery in a specific child with IE, the expected outcome of surgery should be estimated according to these parameters.

There have been no studies with prospectively assigned early- and late-surgery groups and an evaluation according to intention-to-treat, other than the Early vs. Late Infantile Strabismus Surgery Study (ELISSS). The primary outcome of that study was that 13.5% of those operated at approximately 20 months of age against 3.9% (P = 0.001) of those operated at approximately 49 months recognized the Titmus Housefly at the age of 6 years; there was no difference in stereop-sis beyond Titmus Housefly.

Reoperation rates were 28.7% in the early and 24.6% in the late group. 8.2% of the children scheduled for early surgery and 20.1% of the children scheduled for late surgery had not been operated at the age of 6 years; most developed a microstrabismus. Esotropia less than 14° at baseline at approximately 11 months of age had not been operated at the age of 6 years in 35% of the cases. Hypermetropia around spher. + 4 increased the likelihood of regression without surgery, underscoring the need of full refractive correction.

Findings of substantially finer stereopsis after very early surgery await confirmation in a randomized controlled trial.

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Additional indexing

Contributors:Early vs. Late Infantile Strabismus Surgery Study Group
Item Type:Book Section, not refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Ophthalmology Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 February 2010
Deposited On:21 Dec 2009 12:45
Last Modified:05 Apr 2016 13:40
Publisher:Springer
Series Name:Essentials in Ophthalmology
ISSN:1612-3212
ISBN:978-3-540-85850-8 (P) 978-3-540-85851-5 (E)
Publisher DOI:https://doi.org/10.1007/978-3-540-85851-5_11
Related URLs:http://www.springer.com/medicine/ophthalmology/book/978-3-540-85850-8 (Publisher)

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