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According to results from the
Pediatric Eye Disease Investigator Group (PEDIG),
congenital (infantile) esotropia can be confirmed by a
reliable observer by 4 months of age. The minimum
required findings for diagnosis are as follows:
1.
Esotropia--usually 40 to 50
diopters, but with a range of 10 to 90 prism diopters.
2.
Normal neurologic status (except
for strabismus)
3.
Refractive error expected for age
(usually low to moderate hyperopia), correction of which
does not eliminate esotropia.
4.
Asymmetric optokinetic nystagmus
characterized by robust temporal to nasal response and
erratic nasal to temporal response.
In addition, it must be noted that the infant has either
alternation, often with cross fixation or fixation
preference for one eye, implying amblyopia, ideally
these infants 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 . 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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