Long-Term Alignment after Bimedial Rectus Recessions for Infantile Esotropia

ABSTRACT

PURPOSE: Long-term alignment after bimedial recti recessions for infantile esotropia were evaluated in 51 infantile esotropes with angle less than 55 PD. All patients were followed up for more than 2 years (Mean 4.5+/-2.0 years). METHODS: All the patients'charts were reviewed retrospectively. They were divided into three groups as follows 1) orthophoria within +/-8PD, 2) esotropia, and 3) exotropia by final alignment. In each group, immediate postoperative angle of deviation, success rate and stereopsis were evaluated. And the relation between final alignment and immediate postoperative angle of deviation were studied. RESULTS: The mean preoperative deviation of all patients was 44.1+/-6.67 PD (22~54 PD). Monocular preference was shown in 49.1% (25 patients) at the initial visit. Twenty-eight patients (54.9%) were aligned within +/-8 PD of orthotropia after initial surgery and forty-three patients (83.4%) after the second operation. The immediate postoperative deviation averaged 1.2+/-5.17% PD of exotropia in 28 patients who were aligned within +/-8 PD of orthotropia at the last visit. The patients with deviation of +/-3PD immediately after surgery were found to be mostly aligned within +/-8 PD of orthotropia at the last visit (51.7%, p=0.07). Thirty-one of 42 patients (73.8%) had measurable stereopsis and 47.6% of these patients favorable stereopsis better than 800 seconds of arc. The most satisfactory results in the obtaining stereopsis was shown in the patients undergoing surgery between 1~2 years of age. CONCLUSIONS: Bimedial recti recessions for infantile esotropia less than 55 PD were effective as an initial procedure in long-term follow-up for more than 2 years. Orthotropia within +/-3 PD in the immediate postoperative period was desirable for the long-term alignment. Binocularity was best obtained by undergoing early surgery between 1~2 years of age.