Surgical success rate similar between two- and three-muscle approaches to correct large-angle esotropia

Issue: May 10, 2016

VANCOUVER, British Columbia — Mediocre long-term outcomes were achieved after single surgery with either a uniform two-muscle approach or a selective three- to four-muscle approach in cases of large-angle esotropia in children, according to a study presented here.

“The first thing to note is the relatively low surgical success rate [approximately 30%] regardless of the surgery used, and this despite our relatively liberal definition of success,” Matthew C. Weed, MD, said at the American Association for Pediatric Ophthalmology and Strabismus meeting.

Matthew C. Weed

Success was defined as less than 10 ∆D of esotropia or exotropia at both distance and near in the primary position.

Weed and colleagues had noted a number of overcorrections in their patients who had undergone selective surgery for large-angle esotropia and undertook a systematic review of outcomes. The researchers looked at 50 patients with an entry angle of strabismus of at least 45 ∆D who underwent surgery between 1968 and 2013 at the University of Iowa before the age of 7 years and who were followed up for at least 2 years after initial surgery. The comparison group was a random sample of 222 similar patients who had undergone the uniform approach at the same institution. The selective group that was treated with a larger surgical dose initially had on average a larger preoperative deviation.

“The next thing you’ll notice is the dramatically different rate of undercorrection and overcorrection between these two groups,” Weed said.

Undercorrection was found to be more likely in the uniform group (49%), whereas overcorrection was more likely in the selective group (42%), Weed said.

There was no statistically significant difference in reoperation rate between the two approaches.

There was no statistically significant difference in the final alignment outcomes after all reoperations, with the majority of patients being successfully aligned at time of last follow-up, regardless of whether alignment was initially undercorrected with the uniform approach or overcorrected with the selective approach, Weed said.

“Granted, there may be some selection bias in these data, in that one would assume, and perhaps even hope, that those patients who didn’t follow up for at least 2 years and were therefore excluded from the study were on average doing better than those patients who did follow up long term,” Weed said. – by Patricia Nale, ELS

Reference: Weed MC. Long-term surgical outcomes for large-angle esotropia in children. Paper 20 presented at: American Association for Pediatric Ophthalmology and Strabismus 42nd annual meeting; April 6-10, 2016; Vancouver, British Columbia.

Disclosure: Weed reports no relevant financial disclosures.