Surgical outcomes and occurrence of associated vertical stra
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The authors analyzed long-term surgical outcomes of infantile esotropia and the occurrence of associated strabismus, inferior oblique overaction (IOOA), and dissociated vertical deviation (DVD). Clinical factors related to the occurrence of inferior oblique overaction and dissociated vertical deviation in patients with infantile esotropia were also evaluated. Medical records of patients with infantile esotropia, who underwent surgery between 1995 and 2008, were reviewed retrospectively. Included patients were followed for at least 10 years. The incidence and age at development of inferior oblique overaction and dissociated vertical deviation were analyzed. To evaluate predisposing factors for developing inferior oblique overaction or dissociated vertical deviation, patients were divided into two groups: those with infantile esotropia only (group A) and those who developed inferior oblique overaction or dissociated vertical deviation (group B).

A total of 122 patients were enrolled and the mean follow-up period was 16.0 years. The mean number of surgeries was 1.7, and 64 patients achieved optimal horizontal alignment. Fifty (41.0%) patients developed inferior oblique overaction at a median age of 3 years; 54 (44.3%) developed a dissociated vertical deviation at a median age of 5 years. Patients in group B underwent more horizontal surgeries than those in group A, and favorable surgical outcomes between the two groups were not different at the final visit. There were no other significant differences in clinical factors between the two groups.

Approximately, 52.5% of patients achieved favorable surgical outcomes through 1.7 surgeries during the 10-year follow-up period. Dissociated vertical deviation tended to develop at a later age than inferior oblique overaction, and in some cases, up to 20 years after diagnosis of infantile esotropia. To achieve favorable horizontal alignment at the final visit, patients with associated vertical strabismus underwent more horizontal muscle surgeries than patients with infantile esotropia only. The presence of inferior oblique overaction/Dissociated vertical deviation may affect horizontal alignment outcomes.

Source:https://www.ijo.in/article.asp?issn=0301-4738;year=2021;volume=69;issue=1;spage=130;epage=134;aulast=Lee;type=0
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