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Ruben Espino Icazbalceta, Mariana Urdapilleta, Alejandro Zermeno, Jessica Vargas, Claudia Murillo; Amblyopia as a risk factor for recurrence in patients with infantile esotropia treated surgically: 10-year follow-up.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1027.
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© ARVO (1962-2015); The Authors (2016-present)
Amblyopia is a complication present in many types of strabismus, including infantile esotropia. Many surgical techniques have been used to treat these patients. The purpose of this study is to determine the rate of strabismus recurrence in patients treated for infantile esotropia at the end of a 10 year follow up, and if amblyopia is a risk factor for recurrence in these patients. Also, if there is a difference in prognosis comparing two surgical techniques (treating two or three rectus muscles).
We conducted a retrospective clinical study by examining the electronic medical records of 231 patients diagnosed with infantile esotropia and treated in the Strabismus department of our hospital Instituto Oftalmologico Conde de Valenciana in Mexico City from 2001 to 2007. We included 45 patients that had at least a 10 year follow up, treated by medial rectus recession in both eyes or medial rectus recession in both eyes + one lateral rectus plication, also some patients had an oblique muscle or superior rectus muscle surgery.
The mean age was 7.2 years old, 22 patients were assigned to amblyopia group and 23 to none amblyopia group. Overall, 44% patients had poor surgical results at the 10 year follow up, 11% had consecutive exotropia and 33% had residual esotropia. The surgical outcome in both groups was non-statistical different having a p=0.6387 (CI 95%).From the same subjects investigated, we compared the two more common surgeries used. From the 45 patients total, 21 were treated with both medial rectus recession (MRR) and 14 with both medial rectus recession plus lateral rectus plication (MMR+LRP), patients with other surgical techniques were excluded. The mean pre-surgical esotropia was 38.81 ±8.64 PD and 44.29 ±9.77 PD respectively (p=0.090). At the end of the follow up we found that both groups had similar surgical results (p=0.9190; CI 95%).
In our study amblyopia did not prove to be a risk factor for recurrence in patients with infantile esotropia treated surgically after a ten year follow up. In both groups 1 of every 10 patients treated had consecutive exotropia and 3 of every 10 patients had residual esotropia. There was non-statistical difference in surgical outcomes between the MRR and MRR+LRP group. Therefore we recommend that in patients with esodevation of approximated 40-45 PD, perform only a 2 muscle surgery (MRR).
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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