Birch Eileen E, Stager David R
Retina Foundation of the Southwest, Dallas, Texas 75231, USA.
J AAPOS. 2006 Oct;10(5):409-13. doi: 10.1016/j.jaapos.2006.06.010.
The proper timing of surgery for infantile esotropia remains controversial. Early surgery may yield better sensory outcomes whereas later surgery may result in better alignment. Several recent studies reported promising sensory outcomes in small groups of children that underwent surgery by 6 months of age. Here, we present motor and sensory outcomes of a cohort of 50 consecutive children enrolled in a prospective study who had surgery by 6 months of age and were followed for 4-17 years.
Angle of deviation, subsequent surgeries, treatment with spectacles, amblyopia, fusion, and stereopsis were evaluated during follow-up. Outcomes from the early surgery group were compared with a concurrently recruited cohort who had surgery at 7-12 months (n=78).
On the initial visit, both cohorts had the same median angle of deviation (45(Delta)) and similar refractive error; the median angle of deviation increased by the final preop visit (55(Delta)). Postoperatively, both cohorts had alignment within 6(Delta) in 83-94% of cases on all visits. Both cohorts had similar rates of additional surgery, and 44-48% wore hyperopic correction postoperatively. Compared with the 7- to 12-month cohort, more children in the early-surgery cohort had peripheral fusion (78% vs 61%; p < 0.02), central fusion (15% vs 2%; p < 0.01), Randot stereopsis (38% vs 16%; p < 0.003), and Randot stereoacuity of 200 seconds or better (20% vs 9%; p < 0.05).
Early surgery was associated with a higher prevalence of fusion and stereopsis, without adverse motor outcomes.
婴儿内斜视手术的最佳时机仍存在争议。早期手术可能产生更好的感觉功能预后，而晚期手术可能导致更好的眼位矫正。最近的几项研究报告称，在6个月前接受手术的一小群儿童中，感觉功能预后良好。在此，我们报告了一项前瞻性研究中连续纳入的50名6个月前接受手术并随访4至17年的儿童的运动和感觉功能预后。
在随访期间评估斜视度数、后续手术、眼镜治疗、弱视、融合和立体视。将早期手术组的预后与同期招募的7至12个月接受手术的队列（n = 78）进行比较。
初次就诊时，两组的斜视度数中位数相同（45Δ），屈光不正相似；术前最后一次就诊时斜视度数中位数增加（55Δ）。术后，两组在所有就诊时83%至94%的病例眼位矫正至6Δ以内。两组再次手术的发生率相似，44%至48%的患儿术后佩戴远视矫正眼镜。与7至12个月手术队列相比，早期手术队列中有更多儿童具有周边融合（78%对61%；p < 0.02）、中心融合（15%对2%；p < 0.01）、兰多立体视（38%对16%；p < 0.003）以及兰多立体视锐度为200秒或更好（20%对9%；p < 0.05）。
早期手术与融合和立体视的较高发生率相关，且无不良运动功能预后。
