Clinical characteristics and long-term postoperative results of infantile esotropia and myopia

Purpose: To determine the short-term (6 month) and long-term (4 year) surgical results of infantile esotropia in a control group of 100 patients, as compared to a myopia (-2.0 to -5.0 diopters [D]) group of 13 patients and to a high-myopia (greater than -8.0 D) group of 14 patients. Method: A retrospective chart review with selection according to inclusion criteria. Results: All 14 high-myopic patients (100%) achieved short-term unacceptable result of large-angle (greater than 20 prism diopters) deviation as compared to 29 (29%) and four (31%) of the patients in the control and myopia groups, respectively (P<0.0001). Eighty (80%) of the patients in the control group and 10 (77%) in the myopia group achieved long-term favorable postoperative results of subnormal binocular vision, microtropia, or small-angle (less than 20 prism diopters) deviation, with no statistical differences between the two groups. In contrast, 10 (71%) of the patients in the high-myopia group achieved a final unacceptable result of large-angle deviation, as compared to 20 (20%) and three (23%) in the control and myopia groups, respectively (P<0.0001). Persistent preoperative amblyopia was associated with a higher percentage of unfavorable surgical results and was more frequent in the high- myopia group (50%) as compared to the control group (14%) (P=0.0004). Conclusions: Careful attention must be directed preoperatively toward reversing amblyopia and correcting refractive errors because persistent amblyopia at the time of surgery was associated with a higher percentage of unacceptable postoperative large-angle deviation. The conventional amount of recession or resection of muscles should be increased in high-myopic cases with infantile esotropia, because less effect is produced per millimeter of recession/resection initially and, in the long-term, the constant stimulus to accommodative convergence apparently causes recurrent esotropia.