Effects of Surgical Timing on Surgical Success and Long-term Motor and Sensory Outcomes of Infantile Esotropia

Purpose: To investigate the effect of surgical timing on long-term motor and sensory outcomes in patients with infantile esotropia. Methods: The medical records of patients who underwent strabismus surgery for infantile esotropia were reviewed retrospectively. The patients were divided into three groups according to age at the time of surgery: early group (6 to 11 months), late group (12 to 17 months), and very late group (18 to 27 months). The main outcome measures were final alignment, surgical success rate (the angle of deviation at final follow-up of <= 10 prism diopters [PD] of esotropia, no exotropia and no need for reoperation), stereoacuity, visual acuity, and the number of reoperations required during the follow-up. Results: A total of 79 patients (44 female, 35 male) met the inclusion criteria. The surgical success rate was 25.9%, 23.1%, and 53.8% in the three groups, respectively (P = .035). After a mean follow-up of 96 months, the average number of operations per child was 1.7 +/- 0.9, 1.6 +/- 0.6, and 1.4 +/- 0.6 in the three groups, respectively (P = .020). The measurable stereopsis rate was higher in the early group (37% vs 3.8% and 3.8%, respectively) (P = .001). The amblyopia rate was similar between groups. Conclusions: The results show that performing surgery later in life in patients with infantile esotropia increases the motor success rate of surgery. In addition, orthophoria is achieved with fewer surgical operations. However, earlier surgery may improve stereopsis.