Outcome study of surgical alignment before six months of age for congenital esotropia

Background: Recently, several ophthalmic surgeons have reported surgical alignment with congenital esotropia in patients younger than 6 months of age to improve the quality of the binocular result. Methods: The author performed a multicenter independent study of the motor and sensory results obtained in a group of patients younger than 6 months of age. These patients underwent surgical alignment by other investigators to within 10 prism diopters for a minimum of 6 months, The patients had been followed for a minimum of 4 years and were required to have sufficient maturity and normal neurologic status to reliably respond to tests for fusion and stereopsis. The patients were examined and analyzed by the author before any knowledge of the clinical record, Results: Sixteen patients underwent surgical alignment at an average age of 4.2 months. Follow-up examination took place at an average age of 7.1 years. Motor and sensory tests showed 11 patients to have a small or negligible motor misalignment at near point with both binocular fusion and gross stereopsis ability. One patient, aligned by 3 months of age, demonstrated reproducible refined stereoacuity on sensory testing. The author observed, however, that alignment by 4 or 5 months of age did not result in better quality of binocularity than a previously studied group of patients who underwent alignment at 6 months of age. Conclusion: Binocularity that includes refined stereoacuity remains an elusive target and rare outcome for the ophthalmologist treating congenital esotropia, despite the use of very early surgical alignment.