Long term motor and sensory outcome after surgery for infantile esotropia and risk factors for residual and consecutive deviations

Pediatric and Juvenile Strabismus Surgery Under General Anesthesia: Functional Outcomes and Safety

Background/Objectives: The aim of this paper was to evaluate the safety of surgical intervention using anesthesia and ophthalmological parameters in pediatric strabismus patients. The design involved retrospective case series. Methods: The setting was the Department of Ophthalmology, Medical University Vienna, Austria. Participants: In total, 208 children aged 0-18 years who underwent strabismus surgery due to exotropia or esotropia between 2013 and 2020 were included. Main outcomes and measures: Information regarding the duration of surgery, intra- and postoperative complications, the postoperative angle of deviation (AoD), and functional outcomes (visual acuity, stereovision) were analyzed. Results: The mean age at the time of surgery was 6.0 ± 4.1 years (range 0.6-18.0). The mean anesthesia time among all patients was 75.9 ± 19.3 min. The mean surgery and anesthesia time did not differ between the age groups. Longer anesthesia durations and surgery durations did not have a significant effect on the occurrence of intraoperation complications (p = 0.610 and p = 0.190, respectively). Intraoperative complications were recorded in 53% (most frequent triggering of oculocardiac reflex (OCR)) of the patients, and postoperative complications in 22% (the most frequent were postoperative nausea and vomiting and pain). An OCR was triggered more often in children older than 6 years than in younger children (p = 0.016). The mean angle of deviation was significantly reduced from preoperative to postoperative measurements. Preoperative stereovision tests were positive in 35% of the patients and increased to over 80% postoperatively. Conclusions: Strabismus surgery performed under general anesthesia in children aged 0 to 18 years is safe with regard to both surgical and anesthetic complications. A significant decrease in the angle of deviation and high rate of stereovision could be achieved with a low rate of re-treatments. However, the retrospective design, absence of standardized documentation, and limited sample size may affect the consistency and comparability of this study's findings.

Surgical Outcomes and Factors Related to Their Success of Infantile Esotropia in a Tertiary Hospital: A Retrospective Study

Purpose

This study aims to evaluate the outcomes of surgical intervention for infantile esotropia at a tertiary care hospital.

Patients and Methods

Medical records of patients with esotropia who underwent surgical correction at our tertiary hospital between January 2013 and June 2023 were retrospectively analyzed. Patient demographics, preoperative and postoperative ocular alignment, surgical techniques employed, complications or reoperations, and factors related to successful surgery were analyzed.

Results

The study included 77 participants with an average age of 9.54 ± 10.87 years at the time of surgery. Postoperatively, 71.4% (55/77) patients achieved successful alignment, which was defined as an ocular deviation of ≤10 prism diopters (PD), at the final follow-up. The average follow-up period was 12 months, during which no complications were noted. Reoperation was required in 15.6% (12/77) patients. Multivariate logistic regression revealed that having a smaller preoperative deviation of <50 PD positively influenced the success of strabismus surgery (adjusted odds ratio, 7.13; 95% CI, 2.04-24.86).

Conclusion

The surgical correction of infantile esotropia in a tertiary care setting yielded favorable alignment outcomes in most cases, with no complications and a low reoperation rate. A preoperative angle of <50 PD emerged as a prognostic factor for successful surgical outcomes in this population. Further studies with longer follow-up periods are recommended to evaluate the long-term stability of these outcomes and identify additional influencing factors.

Long-term Motor and Sensory Outcomes After Unilateral Medial Rectus Recession-Lateral Rectus Resection for Infantile Esotropia

PURPOSE

To report long-term motor and sensory outcomes after unilateral medial rectus recession-lateral rectus resection for infantile esotropia.

METHODS

The medical records of patients who had undergone unilateral medial rectus recession-lateral rectus resection for infantile esotropia and were followed up postoperatively for a minimum of 10 years were reviewed retrospectively.

RESULTS

A total of 100 patients were included. The mean age at surgery was 2.9 ± 2.2 years (range: 2.5 months to 9.0 years). The mean postoperative follow-up was 15.7 ± 4.4 years (range:10.0 to 27.5 years). Overall, 54 patients (54%) had surgical success at their last follow-up visit. Age at first surgery, strabismus duration, degree of hyperopia, preoperative size of deviation, presence of dissociated vertical deviation, inferior oblique overaction, or both dissociated vertical deviation and inferior oblique overaction, and the number of esotropia surgeries did not predict motor outcome after surgery. Consecutive exotropia developed in 43% of patients (constant in 18% and intermittent in 25%). Residual and recurrent esotropia occurred in 20% and 21% of patients, respectively. Refractive accommodative esotropia developed in 17% of patients and there was a high accommodation convergence/accommodation ratio esotropia in 2%. Peripheral binocular single vision was achieved in 54% of patients and stereopsis in 1%. Patients with 1.5 years or less of strabismus duration had better chances of achieving peripheral binocular single vision.

CONCLUSIONS

Nearly half of the patients with infantile esotropia achieved a successful long-term motor outcome and peripheral binocular single vision. Consecutive exotropia occurred frequently. Recurrent esotropia and refractive accommodative esotropia developed in some patients, and a high accommodation convergence/accommodation ratio esotropia in a few. Stereopsis outcome was extremely poor. [J Pediatr Ophthalmol Strabismus. 2024;61(2):106-113.].

Development and Validation of a Nomogram for Predicting Second Surgery in Patients with Concomitant Esotropia

INTRODUCTION

This study developed and validated a nomogram for predicting the risk of second surgery in patients with concomitant esotropia (CE) based on a cohort in Beijing.

METHODS

In this retrospective cohort study, the inpatient and outpatient medical records of 419 patients with CE who underwent surgery at the Peking University First Hospital between January 1, 2005 and December 31, 2009 were collected. A total of 357 CE cases were included. For those cases 70% were randomly assigned to the training set (n = 234) and 30% to the validation set (n = 123). Demographic and clinical variables were ascertained at hospital admission and discharge and screened using multivariate Cox proportional hazards regression analysis to construct predictive models and generate a 1-, 4-, and 8-year overall survival nomogram. This nomogram provided an estimate of the risk of second surgery in patients with surgically treated CE. Internal validation was conducted using the concordance index (C-index) and calibration curve for the training and validation sets.

RESULTS

Six independent prognostic factors were identified, namely age at surgery, age at onset, amblyopia, deviation angles, surgical amount, and deviation angles 1 week after surgery, and these were entered into the nomogram. The proposed nomogram showed favorable discrimination and accuracy in the training and validation sets. The C-indexes of the training and validation sets were 0.84 (95% CI 0.79-0.89) and 0.80 (95% CI 0.78-0.82), respectively.

CONCLUSIONS

The proposed nomogram can serve as a predictive tool for prognostic evaluation of CE surgery.