Article
Can the preoperative fundus extorsion in infantile esotropia predict the development of postoperative inferior oblique overaction and dissociated vertical deviation?

https://doi.org/10.1016/j.jcjo.2011.07.005Get rights and content

Abstract

Objective

To evaluate the relationship between fundus extorsion before surgery and the development of inferior oblique overaction (IOOA) and dissociated vertical deviation (DVD) after surgery in patients with infantile esotropia.

Design

Retrospective comparative observational study.

Participants

Forty patients who had not had preoperative IOOA or DVD, and had undergone surgery for infantile esotropia were included.

Methods

A fundus examination was carried out under general anesthesia before surgery. There were 21 subjects with preoperative fundus extorsion (extorsion group), and 19 subjects without torsion (no torsion group). The development of IOOA and DVD after surgery was evaluated.

Results

After surgery, IOOA developed in 14 patients (66.7%) and DVD in 17 patients (80%) in the extorsion group. In contrast, IOOA developed in 2 patients (10.5%) and DVD in 6 patients (31.6%) in the no torsion group (p < 0.001, p = 0.002, respectively).

Conclusions

When patients with infantile esotropia had fundus extorsion assessed on general anesthesia before surgery, IOOA and DVD were more likely to develop after surgery.

Résumé

Objet

Évaluation de la relation entre l’extorsion du fond d’œil avant la chirurgie et le développement de l’hyperactivité de l’oblique inférieur (HAOI) et de la dissociation de la déviation verticale (DDV) après la chirurgie chez les patients ayant une ésotropie infantile.

Nature

Étude rétrospective et comparaison d’observations.

Participants

Quarante patients qui n’avaient pas eu de HAOI ni de DDV préopératoire et qui ont subi une chirurgie pour ésotropie infantile.

Méthodes

Un examen du fond d’œil a été effectué sous anesthésie générale avant la chirurgie. On a constaté que 21 sujets avaient une extorsion du fond d’œil avant l’opération (groupe extorsion) et 19 sujets n’avaient pas de torsion (groupe sans torsion). On a ensuite évalué la HAOI et la DDV après la chirurgie.

Résultats

Après la chirurgie, la HAOI s’est développée chez 14 patients (66,7%) et la DDV, chez 17 patients (80%) dans le groupe extorsion. Par contre, la HAOI s’est développée chez 2 patients (10,5%) et la DDV, chez 6 patients (31,6%) dans le groupe sans torsion (P = 0,001 et P = 0,002, respectivement).

Conclusions

Lorsque les patients avec ésotropie infantile avaient subi l’évaluation de l’extorsion du fond d’œil avant l’opération, la HAOI et la DDV étaient plus sujettes à se développer après la chirurgie.

Section snippets

Methods

The study protocol was approved by Institutional Review Board of Korea University Anam Hospital. Among the consecutive patients who had undergone surgery for infantile esotropia in Korea University Anam Hospital between January 2001 and December 2005, 40 patients whose fundus had been examined under general anesthesia before surgery were enrolled in this retrospective study. Before enrollment, oral informed consent was obtained from the parents of the patients. We confirmed the diagnosis of

Results

The mean preoperative and final postoperative distant and near angle size of esotropia, age at the time of surgery, and mean follow-up period after surgery in the 2 groups are shown in Table 1. There was no statistically significant difference in the characteristics of subjects between the 2 groups.

Table 2 shows the development of IOOA and DVD during the follow-up period after surgery. IOOA was present in 14 patients (66.7%) and DVD in 17 patients (80.9%) in the extorsion group, IOOA was

Discussion

Infantile esotropia is described as a congregation of large angle esotropia, IOOA, DVD, and amblyopia.7 When patients with infantile esotropia establish acceptable ocular alignment through early surgical intervention, they are more likely to develop fair binocular function.14, 15, 16 However, IOOA and DVD can develop even if patients achieve acceptable ocular alignment through surgery. Furthermore, the development of IOOA and DVD is hard to predict. Ing et al.17 stated that the development of

Disclosure

The authors have no proprietary or commercial interest in any materials discussed in this article.

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