Stereopsis and Surgical Timing in Infantile Esotropia
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To clarify the relationship between stereopsis outcome and timing of surgical alignment in infantile esotropia.
METHODS
The medical records of otherwise healthy patients with infantile esotropia who underwent surgery by 8 years of age were divided into the following groups according to age at time of surgery: very early surgery (≤8 months), early surgery (>8 to ≤24 months) and late surgery (>24 months). Binocular response and stereopsis were compared between groups.
RESULTS
A total of 76 patients were included: 22 in the very early group, 30 in the early group, and 24 in the late group. Binocular response at near was found in 96% of the very early group and in 80% of the early group, significantly higher than the 50% of the late group (P < 0.001 and P < 0.05 [Dunn test], resp.). Stereopsis was present in 77% of the very early group, significantly higher than the 20% of the early group and 13% of the late group (P < 0.001 [Dunn test]). A significant correlation was also found between age (months) at surgery and stereopsis (seconds) outcome (logarithmic fit: y = 2539.4ln(x) + 147.2; R2 = 0.2691; P < 0.001).
CONCLUSIONS
In this study cohort, earlier surgery was associated with better binocularity in patients with infantile esotropia. Our results suggest that very early surgery, at ≤8 months, can improve the chance for postoperative stereopsis.
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Additional Info
Disclosure statements are available on the authors' profiles:
Relationship Between Stereopsis Outcome and Timing of Surgical Alignment in Infantile Esotropia
J AAPOS 2020 Mar 26;[EPub Ahead of Print], T Yagasaki, Y Yokoyama, M TsukuiFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This study has several gaps in reporting that would have strengthened the authors' conclusions had they been addressed. The first is that, of the 108 records evaluated, 76 patients met their inclusion criteria. Excluding 30% of the cases seems a rather high number, and it would help readers to know why these patients did not meet the inclusion criteria. In a retrospective review of this nature, there is always the temptation to cherry pick the data. Secondly, as the authors report, the motor outcome was not significantly different among the three groups. But we do not know if the need for reoperation differed among the three groups over time. The authors state that the minimum follow-up was for 36 months, but there may have been significant variability in long-term stability. One interesting note is that the authors are primarily looking at stereopsis as a metric for judging the merits of very early surgery, yet this is stereopsis as judged by either random dot or non-random stereo responses, whichever was better. Although many studies emphasize use of random dot stereopsis, these results support that non-RDS targets may be a more useful sensory proxy for maintenance of motor alignment.