Progressive increase in the quantity of deviation in congenital esotropia.

BACKGROUND AND OBJECTIVE

It was the author's clinical impression that many individuals with congenital esotropia demonstrated an increase in the quantity of deviation measured over time. The present study statistically examines the prevalence and quantity of increase in the amount of deviation measured for a consecutive series of patients with congenital esotropia prior to surgical alignment.

PATIENTS AND METHODS

A retrospective chart review was conducted for patients treated during a 5-year period. Data were recorded for the initial and final measurements of the strabismus and the initial and final surgical plans prior to surgery. Also recorded were the age at surgery, length of observation before surgery, refraction, use of patching, and initial motor alignment outcome.

RESULTS

Approximately 50% of 41 patients showed an average increase of 20 prism diopters (PD) in the quantity of the deviation when they were observed for an average of 3 months. The age at initial measurement, age at surgery, length of observation prior to surgery, refraction, or use of patching could not be used to identify patients with the increase in the amount of strabismus. However, in cases where the final surgical plan was based on the measurements made the day before surgery, 90% of the patients showed an initial surgical alignment to within 10 PD or orthotropia by 6 weeks postoperatively.

CONCLUSIONS

These data indicate that a significant increase in the amount of preoperative deviation is very prevalent in patients being observed for congenital esotropia. This finding suggests that the timing of preoperative measurements is very important, and that the data collected close to the date of surgery are the most important with which to plan surgery.