Interventions for infantile esotropia

Elliott, Susan L.; Shafiq, Ayad

doi:10.1002/14651858.cd004917.pub2

Cited by 15 publications

(6 citation statements)

References 30 publications

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“…This can be associated with the appearance of limited abduction (outward movement) of the other eye; manifestlatent nystagmus: oscillation of the eyes, which increases when either eye is covered; asymmetry of optokinetic nystagmus: a following movement followed by a rapid fixation movement in the opposite direction. 1 The main reason for presentation of children with infantile esotropia is usually parental awareness of unacceptable ocular misalignment.…”

Section: Comparison Of Bilateral Medial Rectus Recession Vs Recession-resection As Surgery For Infantile Esotropiamentioning

confidence: 99%

“…However, another important issue to consider is whether such treatment facilitates and enhances the development of binocular vision. Therefore, there are two aims of intervention: (1) to align the visual axis, (2) to optimise the potential for binocularity. Many authorities believe that alignment to within 10 dioptres (^) of orthotropia 'straight eyes' by two years of age offers the best prospect for the development of binocular vision.…”

Section: Comparison Of Bilateral Medial Rectus Recession Vs Recession-resection As Surgery For Infantile Esotropiamentioning

confidence: 99%

“…Strabismus (squint) is a misalignment of the eyes in which the visual axes deviate from bifoveal fixation. 1 It can be subdivided into esotropia (inward deviation), exotropia (outward deviation) or, less commonly, hypertropia (upward deviation), hypotropia (downward deviation) and cyclotropia (torsional deviations -inwards, incyclotorsion or out outwards, excyclotorsion). This study specifically looked at infantile esotropia (IE).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of bilateral medial rectus recession vs recession-resection as surgery for infantile esotropia

et al. 2021

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Background: Infantile esotropia is misalignment of eyes from bifoveal fixation where surgical correction at an early age usually presents with good outcomes. Aims and Objective: To compare the surgical outcome between bilateral medial rectus recession (BMR) and recession- resection (RR) surgery in infantile esotropia. Materials and Methods: The study was conducted in Lumbini Eye Institute, Bhairahawa, from December 2017 to December 2018. Patients with infantile esotropia who underwent surgical correction were included in the study. Patients were examined pre operatively, and post operatively at day one and third month, where the angle of deviation was measured and the level of binocular single vision (BSV) was assessed. Data was entered and analyzed using the SPSS program. Results: Total 79 patients were included in the study out of which 33 underwent BMR and 46 underwent RR. The mean pre-operative angle by PBCT was 52.58 PD (SD ±15.468) in the BMR group and 47.83 PD (SD ±12.140) in the RR group. Post-operative deviation in the BMR group had angle <35 PD. In the RR group the post-operative deviation observed was <35 PD, whereas 1/46 patients had angle between 35-50 PD. All patients who had residual esotropia (ET) in either the BMR or RR group had a pre-operative angle above 50 PD. Pre-operatively 43% had fusion and rest of them had suppression. Post-operatively 40.5% had fusion, 15.2% had stereopsis and rest of them had suppression or BSV could not be assessed in them. Therefore, there was increase in BSV by 2.5% from fusion to stereopsis. Those who initially showed suppression or in whom the BSV could not be assessed pre-operatively now showed to have fusion or some stereopsis. In total there was 15.2% increase in stereopsis. Conclusion: Though cosmesis has been improved in most patients after strabismus surgery, BSV improvement was insignificant as most surgery was performed after attainment of visual maturity. No significant difference between BMR and RR was found in terms of improvement of angle of deviation and BSV.

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Section: Comparison Of Bilateral Medial Rectus Recession Vs Recession-resection As Surgery For Infantile Esotropiamentioning

confidence: 99%

Section: Comparison Of Bilateral Medial Rectus Recession Vs Recession-resection As Surgery For Infantile Esotropiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of bilateral medial rectus recession vs recession-resection as surgery for infantile esotropia

et al. 2021

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“…Despite evidence that disruption in the visual system early in life leads to poor binocularity, there still seems to be no consensus on the best timing for surgical intervention. Elliott and Shafiq performed a Cochrane review and found that there are no prospective, randomized trials to answer the question of timing of surgery in infantile esotropia [4]. So, pediatric ophthalmologists use preferences learned during training, previous studies, and personal experience to drive their decision making.…”

Section: Timing Of Treatmentmentioning

confidence: 99%

Management of infantile esotropia

Hug

2015

Current Opinion in Ophthalmology

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Although many theories exist, the true cause of infantile esotropia remains unknown. The literature suggests that treatment before age 2 and perhaps even earlier improves the potential for binocular vision. After significant review of literature, it is clear that surgery is the treatment of choice for infantile esotropia but no method has a clear advantage. Efforts to define the best surgical procedure and timing of surgery through prospective, randomized multicenter trials are warranted.

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“…The current clinical impression is that surgery can improve the control of these squints, but this may not last and there is a significant and unpredictable risk of overcorrection: this can be a long-term problem even after further surgical intervention. 27,28 However, as shown in two Cochrane Database systematic reviews, empirical evidence regarding the optimum management of any kind of strabismus is limited, 29,30 and therefore, it is difficult for health professionals to advise parents on the pros and cons of available options. Indeed, a recent study revealed temporal and geographical variations in rates of childhood squint surgery within one country 31 – such variations are no doubt linked to this deficiency in evidence regarding management of childhood strabismus.…”

Section: Introductionmentioning

confidence: 99%

Surrendering control, or nothing to lose: Parents’ preferences about participation in a randomised trial of childhood strabismus surgery

et al. 2015

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Opposition to surgery and concerns about surrendering control were common obstacles to participation, whereas parents keen for their child to undergo the operation but happy to defer tended to embrace a 'nothing to lose' attitude. Many non-participants would have consented if allowed to choose group, although most of these would have chosen observation. While most parents felt happy with information given and that randomisation was adequately explained, it is of concern that there may be some misunderstanding, which should be addressed in any trial. These findings will inform future trials in childhood exotropia, for example, consideration of preference arms and improving communication. Lessons learnt from the Surgery versus Active Monitoring in Intermittent Exotropia trial could prove valuable to paediatric and surgical trials generally.

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Interventions for infantile esotropia

Cited by 15 publications

References 30 publications

Comparison of bilateral medial rectus recession vs recession-resection as surgery for infantile esotropia

Comparison of bilateral medial rectus recession vs recession-resection as surgery for infantile esotropia

Management of infantile esotropia

Surrendering control, or nothing to lose: Parents’ preferences about participation in a randomised trial of childhood strabismus surgery

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