High-grade stereo acuity after early surgery for congenital esotropia

K. W. Wright, P. M. Edelman, J. H. McVey, A. P. Terry and M. Lin
Department of Ophthalmology, University of Southern California, Los Angeles.

OBJECTIVE: To evaluate the effectiveness of very early surgery for establishing straight eyes and sensory fusion in patients with congenital esotropia. DESIGN: A review of consecutive patients with congenital esotropia who underwent surgery between 13 and 19 weeks of age. SETTING: A children's hospital with a teaching affiliation. PATIENTS: Seven patients who had surgery between 13 and 19 weeks of age. INTERVENTION: A bilateral medial rectus recession through a fornix incision with recessions ranging from 5.75 to 6.5 mm in infants younger than 6 months of age. MAIN OUTCOME MEASURES: Sensory fusion as measured by stereo acuity and Worth four-dot testing and motor alignment within 8 prism diopters. RESULTS: Five of the seven patients achieved essentially straight eyes with tropias of less than 8 prism diopters after one horizontal surgery. Five patients cooperated with sensory testing, and all showed stereo acuities that ranged from 400 to 40 seconds of arc. Three children had evidence of high-grade stereo acuity by showing stereopsis on random dot stereograms (Randot, Stereo Optical Co, Chicago, Ill) and by fusing the Worth four-dot test at distance and near range. Two of the patients with high-grade stereo acuity achieved a stereo acuity of 40 seconds of arc by Titmus testing; however, one had a late reduction of stereo acuity to 70 seconds of arc. CONCLUSION: Very early surgery can result in excellent motor alignment and high-grade stereo acuity in some patients with congenital esotropia.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Timing of Surgery for Infantile Esotropia in Humans: Effects on Cortical Motion Visual Evoked Responses
Gerth et al.
IOVS 2008;49:3432-3437.
ABSTRACT | FULL TEXT  

Duration of Binocular Decorrelation Predicts the Severity of Latent (Fusion Maldevelopment) Nystagmus in Strabismic Macaque Monkeys
Richards et al.
IOVS 2008;49:1872-1878.
ABSTRACT | FULL TEXT  

The Critical Period for Susceptibility of Human Stereopsis
Fawcett et al.
IOVS 2005;46:521-525.
ABSTRACT | FULL TEXT  

Early Versus Delayed Repair of Infantile Strabismus in Macaque Monkeys: II. Effects on Motion Visually Evoked Responses
Tychsen et al.
IOVS 2004;45:821-827.
ABSTRACT | FULL TEXT  

Effects of the Duration of Early Strabismus on the Binocular Responses of Neurons in the Monkey Visual Cortex (V1)
Mori et al.
IOVS 2002;43:1262-1269.
ABSTRACT | FULL TEXT  

Early surgery for infantile esotropia
Shirabe et al.
Br. J. Ophthalmol. 2000;84:536-538.
ABSTRACT | FULL TEXT  

Effect of Onset Age of Strabismus on the Binocular Responses of Neurons in the Monkey Visual Cortex
Kumagami et al.
IOVS 2000;41:948-954.
ABSTRACT | FULL TEXT  

Early retreatment of infantile esotropia: comparison of reoperation and botulinum toxin
Tejedor and Rodríguez
Br. J. Ophthalmol. 1999;83:783-787.
ABSTRACT | FULL TEXT  

Critical Periods and Amblyopia
Daw
Arch Ophthalmol 1998;116:502-505.
ABSTRACT | FULL TEXT