Congenital (infantile) esotropia is an ET that
appears in an infant in the first 6 months of
life with normal neurologic status, with normal
ocular examination (except for strabismus) and
with a refractive error expected for age
(usually low to moderate hyperopia), the
correction of which does not eliminate esotropia.
The
infant
has either alternation with cross fixation or
fixation preference for one eye ( implying
amblyopia ), these infants with fixation
preference should
alternate fixation before surgery, but surgery
is often carried out by many surgeons before
this is accomplished. Amblyopia therapy in such
cases can be continued after surgery.
The age chosen for surgery depends on the
surgeon’s preference and varies from as early as
4 months to 3 years of age or more if
alternation is confirmed. For me I do surgery
for infantile esotropia as early as 4 months'
age , as long as the diagnosis is confirmed by
the above criteria . For me early interference
results are the same as late interference which
is preferred by many colleagues , this was
confirmed by the long term follow up of hundreds
of cases within our hands' statistics .
Surgery for infantile esotropia consists of
bimedial rectus recession, , a three-muscle
procedure combining a bimedial rectus recession
with a resection of one lateral rectus or in a
very few cases a four-muscle procedure
consisting of a bilateral recession-resection.
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