Spontaneous resolution of early-onset esotropia: experience of the congenital esotropia observational study

doi:10.1016/S0002-9394(01)01316-2

American Journal of Ophthalmology

Volume 133, Issue 1, January 2002, Pages 109-118

https://doi.org/10.1016/S0002-9394(01)01316-2 Get rights and content

Abstract

PURPOSE: To determine the probability of spontaneous resolution of esotropia with onset in early infancy.

DESIGN: Prospective multicenter cohort study.

METHODS: Eligibility criteria included age at enrollment 4 to < 20 weeks and an esotropia measuring at least 20 prism diopters (pd). The primary outcome measure was ocular alignment at 28 to 32 weeks of age. The esotropia was classified as resolved when there was a misalignment of 0 to 8 pd at the outcome examination either with or without spectacle correction.

RESULTS: Outcome data were available for 170 of the 175 enrolled patients. The esotropia was classified as resolved in 46 of the 170 patients (27%, 95% confidence interval = 21% to 34%). Most of the resolved cases had an intermittent or variable deviation at enrollment. Resolution occurred in only one of 42 cases that had a constant esotropia ≥ 40 pd on both the baseline and first follow-up examination and had a refractive error ≤+ 3.00 diopters. In another patient, who had an esotropia of 35 pd at baseline and 40 pd at the outcome examination, the esotropia resolved subsequent to the outcome examination.

CONCLUSIONS: Esotropia with onset in early infancy frequently resolves in patients first examined at less than 20 weeks of age when the deviation is < 40 pd in size and is intermittent or variable. Cases with a constant deviation ≥ 40 pd presenting after 10 weeks of age have a low likelihood of spontaneous resolution. Our results can be used to define a clinical profile for which persistence of the esotropia is sufficiently likely that surgical correction at 3 to 4 months of age could reasonably be considered.

Section snippets

Methods

The study was conducted by 137 investigators at 104 clinical sites. Investigators were fellowship-trained pediatric ophthalmologists with at least 1 year of clinical practice experience. An institutional review board approved the study for each site and written informed consent was obtained for participation. An independent monitoring committee provided study oversight.

Baseline characteristics

: Between December 1997 and July 2000, 175 patients were enrolled by 137 certified investigators. The age of the patients at the time of the initial visit (baseline) ranged from 4 weeks (29 days) to 19 weeks (139 days) and averaged 14 weeks (97 ± 26 days); 54% of the patients were female and 76% were Caucasian.

The esotropia at baseline was characterized as constant in 98 (56%) of the patients, variable in 43 (25%), and intermittent in 34 (19%). Most of the large-angle deviations (≥ 40 pd) were

Discussion

In this multicenter observational study of 170 patients with early-onset esotropia who were enrolled at 4 to < 20 weeks of age, we found that the esotropia resolved without surgery by the outcome examination (at 28 to 32 weeks of age in most patients) in 46 patients (27%). Resolution was spontaneous in 42 patients and concomitant with spectacle wear in 4 patients. Whether wearing spectacles contributed to the resolution in these patients is unknown since most patients who had hyperopia treated

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Cited by (85)

Nonsurgical Treatment of Strabismus
2022, Advances in Ophthalmology and Optometry
Citation Excerpt :
An outcome visit was conducted between 28 and 32 weeks of age. The esotropia resolved in 27% of patients, 8.7% of whom were treated with spectacles [4]. An additional 4% of patients experienced resolution after the end of the study but before the age of 1 year [4].
Long term outcomes of botulinum toxin injections in infantile esotropia
2021, Journal Francais d'Ophtalmologie
Évaluer l’efficacité à long terme de la toxine botulique dans le traitement de l’ésotropie précoce grâce au pourcentage de microtropie à 24 mois post-injection. L’objectif secondaire était de rechercher les facteurs prédictifs à l’obtention de cette microtropie.
Nous avons réalisé une étude rétrospective, monocentrique au Centre Hospitalier universitaire (CHU) de Bordeaux entre 2001 et 2018 en incluant tous les patients ayant une ésotropie précoce. Ces patients ont reçu une injection bilatérale de 5 ou 7,5 unités de toxine botulique à une ou deux reprises en fonction de l’angle après la première injection et port de la correction optique totale. L’ensemble des caractéristiques sociodémographiques et ophtalmologiques ont été recueillis en préopératoire. Nous avons noté l’angle à 1,6,12 et 24 mois ; l’apparition de complications ainsi que la nécessité d’une chirurgie de strabisme à distance. Le critère de jugement principal était l’obtention d’une microtropie inférieure à 8 dioptries (D) à 24 mois post-injection. Nous avons évalué les facteurs prédictifs de la microtropie par un test de Fischer.
Nous avons inclus 30 patients ayant une ésotropie supérieure à 20 D avec un délai moyen de suivi post-injection de 48 mois ± 30. L’âge moyen était de 16,24 mois (7–29 mois) avec une prédominance féminine dans la population (sex ratio SR = 0,43). L’angle moyen pré-injection était de 41,25 ± 12,17 D. Il y avait une majorité d’hypermétropes légers (40 %) et modérés (40 %). À 24 mois, on obtenait 46,7 % de microtropies (intervalle de confiance : IC 95 % : 28,9 %–64,5 %). L’évolution de l’angle moyen à 1,6,12 et 24 mois post-injection était respectivement de −8,57 ± 25,21 D ; 14,48 ± 13,40 D ; 18,38 ± 12,07 D et 21,23 ± 14,97 D. Aucun facteur n’était prédictif de l’obtention d’une microtropie. Parmi les 30 enfants, 3 ont eu des ptôsis transitoires nécessitant la pose de strips et 12 ont présenté une exotropie à 1 mois. Toutes les complications étaient spontanément résolutives et sans conséquences. 3 enfants ont eu une seconde injection de toxine botulique permettant dans 2/3 des cas l’obtention d’une microtropie durable. 26,7 % (n = 8) des enfants ont été opérés secondairement ; l’obtention d’une microtropie à 24 mois diminuait de façon statistiquement significative les chirurgies secondaires du strabisme : p = 0,039 % IC 95 % (0,002 ; 1,0606).
La toxine botulique semble être une alternative moins invasive et plus conservatrice que la chirurgie chez les enfants présentant une ésotropie précoce. Elle permet l’obtention d’une microtropie dans 46,7 % des cas. On notait une amélioration chez 90 % (n = 27) des enfants avec une réduction de la moitié (21,23 D) de l’angle moyen post-injection à 24 mois. Lorsqu’elle est efficace elle réduit significativement les chirurgies secondaires.
To evaluate long terms outcomes of botulinum toxin in infantile esotropia by measuring the amount of microtropia 24 months after injection. Secondary purpose was to identify predictive factors of microtropia.
A retrospective, single-center study was performed at the university medical center in Bordeaux between 2001 and 2018, including all patients with infantile esotropia greater than 20 D. All patients received 5 or 7,5 IU of botulinum toxin A in each medial rectus, once or twice depending on the angle of deviation after the first injection and after wearing full optical correction at least two months. We noted the angle at 1, 6, 12 and 24 months, the occurrence of any complications and the need for later strabismus surgery. The primary endpoint was the achievement of a microtropia less than 8 diopters (D) at 24 months post-injection. We evaluated the predictive factors for microtropia with a Fischer's test.
We included 30 patients with esotropia greater than 20 D. The mean follow-up after injection was 48 months ±30. The mean age was 16.24 months (7–29 months) with a female predominance in the population (SR = 0.43). The mean pre-injection deviation was 41.25 ± 12.17 D. The majority of patients were mildly (40%) or moderately (40%) hyperopic. At 24 months, 46.7% microtropias were obtained (95% CI: 28.9%–64.5%). The change in mean angle at 1, 6, 12 and 24 months post-injection was −8.57 ± 25.21 D; 14.48 ± 13.40 D; 18.38 ± 12.07 D and 21.23 ± 14.97 D, respectively. No factors were predictive of microtropia. Of the 30 children, 3 had transient ptosis requiring strips and 12 showed an exotropia at 1 month. All complications were self-limited and without consequences. 3 children had a second injection of botulinum toxin, which in 2/3 of the cases resulted in a long-lasting microtropia. 26.7% (n = 8) of the children underwent secondary surgery. Obtaining a microtropia 24 months after injection statistically significantly reduced the need for secondary strabismus surgery: 92.9% P = 0.039% CI 95% (0.002; 1.0606).
Botulinum toxin appears to be a less invasive and more conservative alternative to surgery in children with infantile esotropia. In 46.7% of cases, microtropia is achieved. An improvement was noted in 90% (n = 27) of the children with a reduction of half (21.23 D) of the mean post-injection angle at 24 months. When effective, it significantly reduces the need for secondary surgery.
Pickwell’s Binocular Vision Anomalies
2021, Pickwell's Binocular Vision Anomalies
Surgical outcomes after unilateral horizontal rectus surgery in children with infantile esotropia for the correction of A or V pattern
2019, Journal Francais d'Ophtalmologie
Citation Excerpt :
However, discrepancies on when to perform surgery are reported throughout the world. For instance, In North America, the typical age at surgery ranges from 11 to 18 months, and in many parts of Western Europe, surgery is delayed until 2 to 4 years of age or even later, given the probability of spontaneous resolution in some cases of esotropia [19,20]. Some limitations have to be accounted, for instance the small sample studied.
The management of A or V pattern deviation associated with esotropia can be challenging since the horizontal deviation changes with position of gaze. This study aimed to assess the effect of unilateral horizontal rectus surgery for the correction of horizontal deviation associated with A or V pattern in children with non-comitant infantile esotropia.
Twenty-seven children with infantile esotropia and A-V pattern, more than 10 and 15 prism diopters respectively, were included in this retrospective observational single-center study. Horizontal rectus surgery was performed on the most deviated eye under general anesthesia. The patients were divided into two groups: A pattern and V pattern. The outcome measures were change in the amount of pattern and rate of regression after surgery. The amount of pattern was characterized by the difference in esodeviation between upgaze and downgaze.
Horizontal deviation at distance and near fixation decreased significantly (P < 0.0001). Vertical gaze esotropia disparity decreased significantly (P = 0.01 and P = 0.0002 for A and V patterns respectively). A pattern esotropia was reported in only 2 (7%) cases after surgery compared to 9 (33%) before surgery. The number of subjects with V pattern esotropia decreased from 18 (67%) to 3 (11%) after surgery.
The mechanisms involved in the pathophysiology of A and V patterns may not always be related to oblique muscle dysfunction. These findings suggest that unilateral horizontal rectus surgery may be an effective procedure to correct both horizontal deviation and A-V pattern in non-comitant infantile esotropia.
La chirurgie des ésotropies associées à des incomitances alphabétiques est complexe du fait de la variation angulaire horizontale selon la position du regard. Cette étude avait pour objectif d’évaluer l’effet d’une chirurgie unilatérale sur les droits horizontaux chez des enfants présentant une ésotropie précoce et une incomitance alphabétique A ou V (∑ A ou V).
Vingt-sept enfants opérés pour une ésotropie précoce associée à une incomitance alphabétique ∑ A ou V significative, de plus de 10 et 15 dioptries prismatiques respectivement, ont été inclus dans cette étude retrospective observationelle monocentrique. Les sujets étaient répartis en deux groupes : ∑ A ou ∑ V. Le degré d’incomitance a été évalué avant et après chirurgie et l’évolution du nombre de sujets avec une incomitance alphabétique significative après chirurgie. Le degré d’incomitance était caractérisé par la différence de l’ésodéviation entre le regard en haut et en bas.
En postopératoire, l’ésotropie de loin et de près diminuait significativement (p < 0,00001). Le degré d’incomitance diminuait significativement (p = 0,01 et p = 0,0002 pour les incomitances alphabétiques A et V respectivement). Avant chirurgie, 9 (33 %) sujets présentaient un ∑ A contre 2 (7 %) après chirurgie. Avant chirurgie, 18 (67 %) sujets présentaient un ∑ V contre 3 (11 %) après chirurgie.
Les mécanismes impliqués dans la physiopathologie des incomitances alphabétiques A ou V associées à une ésotropie précoce n’impliquent pas uniquement des dysfonctions des muscles obliques. Ces résultats suggèrent que la chirurgie unilatérale horizontale des droits horizontaux puisse permettre chez des sujets avec une ésotropie précoce d’améliorer à la fois l’ésotropie en position primaire et l’incomitance alphabétique.
Long-term Surgical Outcomes for Large-angle Infantile Esotropia
2018, American Journal of Ophthalmology
To report the long-term surgical outcomes for a cohort of children with large-angle infantile esotropia.
Multicenter, nonrandomized clinical study.
Setting: Two tertiary-care pediatric hospitals. Study Population: Children with large-angle (≥55 prism diopters) infantile esotropia. Intervention: Surgical treatment of infantile esotropia. Main Outcome Measure: Success rate at final follow-up (postoperative deviation ≤ 10 prism diopters and no need for retreatment).
A total of 88 patients with large-angle infantile esotropia were treated during the 13-year study period. Treatment was bilateral medial rectus muscle recessions in 70 patients, botulinum toxin–augmented surgery in 15 patients, and 3-muscle surgery in 3 patients. After a mean follow-up of 40 months, 20 patients (23%) had a successful outcome compared to 68 treatment failures (77%). Of the 68 treatment failures, 59 had residual or recurrent esotropia and 9 had sequential exotropia. On multivariate logistic regression, treatment modality was the only factor significantly associated with a successful outcome. Specifically, patients treated with botulinum toxin–augmented surgery were more likely to have a successful outcome compared to patients treated with bilateral medial rectus muscle recessions. For the 26 patients (30%) who underwent retreatment, the mean number of procedures was 2.1, and 7 (27%) had a deviation of ≤10 prism diopters at final follow-up.
The overall success rate for treatment of large-angle infantile esotropia was poor in this cohort, with most failures owing to recurrent or residual esotropia. Botulinum toxin–augmented surgery was associated with a higher success rate at final follow-up.
The incidence, clinical features, and management of essential infantile esotropia in the United Kingdom. A British Ophthalmology Surveillance Unit (BOSU) study
2024, Eye (Basingstoke)

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^☆: Supported by a cooperative agreement from the National Eye Institute, Bethesda, MD: EY11751 and EY12107.

¹: A complete list of the Investigator group is listed at the end of this article.

²: Address reprint requests to PEDIG Data Coordinating Center, Jaeb Center for Health Research, 3010 East 138th Avenue, Suite 9, Tampa, FL 33613; e-mail: [email protected]

^e1: [email protected]

View full text

Original articleSpontaneous resolution of early-onset esotropia: experience of the congenital esotropia observational study22☆,

Abstract

Section snippets

Methods

Baseline characteristics

Discussion

Ophthalmology

Vision Res

Ophthalmology

Ophthalmology

Current controversiesVery early versus early or late surgery for infantile esotropia

Can J Ophthalmol

The clinical spectrum of early-onset esotropia. Experience of the congenital esotropia observational study

Am J Ophthalmol

The natural history of infantile esotropia during the first six months of life

JAAPOS

Vanishing infantile esotropia

Can J Ophthalmol

Prospective assessment of acuity and stereopsis in amblyopic infantile esotropes following early surgery

Invest Ophthalmol Vis Sci

Prospective study of the development of strabismus during the first 6 months of life

Orthoptic Horizons

Progressive increase in the angle of deviation in congenital esotropia

Trans Am Ophthalmol Soc

Binocular interaction in striate cortex of kittens reared with artificial squint

J Neurophysiol

Original article
Spontaneous resolution of early-onset esotropia: experience of the congenital esotropia observational study² ²☆,