Different opinions arose in the last few years about the timing for operating chidren with congenital esotropia? What do you suggest and why on the basis of strong scientific evidence?
There are two different opinions.
In the USA the strabismologists would prefer to operate at the age of 1 - 1.5 years, as some studies have showed that stereopsis can be a littel bit saved. The disadvantage of the this opinion is that the angle is not accurately measured and there may be tendency for re-operations, also if the inferior oblique overaction or DVD are not appeared to that time.
In Germany and most of european countries there is the opinion that the strabismologist should wait till the school age to operate. The idea is that at this age the angle can be accurately measured and the amblyopia treatment should have had its effect. On the other side if there ist associated inferior oblique overaction, it could be at the same time operated. And the most stabismologists think that most the children with congenital esotropia don't develop stereopsis.
1. The CEOS found that infantile esotropia persists in 98% of infants who have large-magnitude (≥20° or 40 PD) constant esotropia with onset after 10 weeks of age and refractive error ≤3.00 diopters. Thus these patients will benefit from early surgery.
2. Go through doi: 10.3129/i08-115 , Wong et al. The protocol attached is from this study.
3. The ELISS study (early vs. late infantile strabismus surgery study) also reported that children operated early had better gross stereopsis at age six as compared to children operated late .
4. Rule out an unstable angle of deviation and a paralytic component, then do early surgery for chances of stereopsis. This study also confirms the same.
Hirabe H, Mori Y, Dogru M, et al
Early surgery for infantile esotropia
British Journal of Ophthalmology 2000;84:536-538.
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