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T. Mori, K. Yago, T. Iida; Long–Term Effects of the Timing of Surgical Corrections for Infantile Esotropia on Binocular Functions and Later Alignment . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2453.
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Previously we reported that early correction of strabismus is important in preserving the disparity sensitivity of neurons in the primary visual cortex (V1) of infant monkeys (Mori et al, IOVS, 2002). Because normal disparity sensitivity of neurons in the early stages of cortical processing is a fundamental requirement for alignment, fusion, and stereopsis, we systematically investigated how the age of surgical correction in strabismic patients influences the degree of fusion, later alignment and prevalence of stereopsis. Because the stability of fixation and alignment of infants that receive surgical corrections is known to exhibit considerable changes over time, we systematically observed our subjects over a period of 10 years.
Seventeen cases of early strabismus were analyzed. The age at which surgical and/or optical corrections were made ranged between 10 months and 6 years. Cover test (APCT) was used to assess alignment and Titmus stereo–tests were employed to assess stereopsis in addition to photographic examinations of alignment. Fusion was examined with Synoptophore test. The overall evaluation of surgical success was done using a traditional von Noorden approach of dividing the subjects into 4 categories, i.e., ideal, satisfactory, acceptable, and unsatisfactory.
The best results for fusion, alignment, stereopsis and overall success were obtained in two subjects that received surgical correction of esotropia at 10 and 11 months of age. The worst results were obtained in two subjects that received surgical corrections after 4 years of age. The mixed results were obtained in the group in which surgical corrections were made between 1 and 4 years of age (n = 13), but the outcome was generally better when corrections were made within 2 years of age.
Our results generally agree with the clinical opinion that surgical and/or optical corrections of infantile strabismus should be made at the earliest possible age following the detection of misalignment to preserve fusion, stereopsis, and/or later alignment.
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