Long-Term Results of Three or Four Horizontal Muscles Surgery in Large Angle Infantile Esotropia

ABSTRACT

Long-term surgical results for 3 or 4 horizontal muscles surgery were evaluated in 58 infantile esotropes with large angle of 55 PD or more. They were followed up for 2 years or more(mean 5.6+/-2.16 years). The mean preoperative deviation was 63.2(+/-5.30)PD, ranging from 55 to 75 PD. Monocular preference was shown in fifty seven percent(34 patients)at the first visit. Thirty eight patients(65.5%)were aligned within+/-8 PD of orthotropia after primary procedure and forty nine patients(84.5%)after the second operation. The immediate postoperative deviation averaged 4.8+/8.99 PD of exotropia in 38 patients all of whom were aligned within+/-8 PD of orthotropia at the last visit. Prospectively, the patients with immediate overcorrection of 4 to 9 PD of orthotropia after surgery were found to be mostly aligned within 8 PD of orthotropia at the last visit. Among the 49 patients with stereopsis testing, 29 patients(58%)had measurable stereopsis and 70%of these patients had favorable stereopsis of 800 seconds or less. In conclusion, 3 or 4 horizontal muscles surgery was effective as initial procedure in large angle infantile esotropia with 55 PD or more deviation. Small amount of exotropia less than 10 PD in the immediate postoperative period was desirable for the best long-term alignment.