Document Detail

Predictive value of age, angle, and refraction on rate of reoperation and rate of spontaneous resolution in infantile esotropia.
MedLine Citation:
PMID:  20843185     Owner:  NLM     Status:  MEDLINE    
METHODS: The ELISSS reoperation rates were first compared with those found in nine series of consecutive cases in nine university clinics operated during one particular year, between 6 and 23 years previously. Logistic regression was used to estimate the effect of postoperative angle and clinic on the chance of reoperation. Secondly, a meta-regression analysis was done of these and other reported reoperation rates. The mean age at operation and the mean duration of follow-up were regressed on the logistically transformed reported reoperation rates. Finally, to estimate the chance of spontaneous decrease of the angle without surgery, a random-effects model was fitted on the 6-monthly orthoptic measurements of angle and refraction in the ELISSS that antedated surgery, loss to follow-up, or final examination. In the random-effects model (see online-only supplement link or visit,, for ELISSS patients the random effect was defined as the deviation of the average angle, the fixed effect. A vector was defined based on age and spherical equivalent of the patient. The variance around the prediction consisted of uncertainty in the estimations, random effects, and residuals.
RESULTS: In the retrospective study, 204 patients who had been first operated between 6 and 23 years previously were eligible. A reoperation had been performed in 32 (19.3%) of the remaining 166 children who were 4.33 SD 1.35 years old at first surgery. The reoperation rate was 7.3% for those with a postoperative angle of -4° to +4° (N = 82), 25% for postoperative divergence > 5°, and 29% for postoperative convergence 10° to 14°. Strabismologists overestimated the reoperation rates at double. In the meta-regression analysis, 12 studies were included. Reoperation rates were between 60% and 80% for children first operated around age 1 and approximately 25% for children operated around age 4 (best fit: -0.221 Ln [age in months] + 1.1069; R(2) = 0.5725). Finally, in the predictions of random-effects model, a small angle at age 1 and hyperopia of approximately +4 increased the chance of spontaneous decrease of the angle into a microstrabismus.
DISCUSSION: The benefit of early surgery for gross binocular vision is balanced by a higher reoperation rate and an occasional child being operated that would have had a spontaneous decrease into a microstrabismus without surgery. The fact that, in the ELISSS, hyperopia was associated with a decrease of the angle underscores the benefit of early refractive correction.
H J Simonsz; M J C Eijkemans
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  Strabismus     Volume:  18     ISSN:  1744-5132     ISO Abbreviation:  Strabismus     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-16     Completed Date:  2011-03-29     Revised Date:  2013-04-23    
Medline Journal Info:
Nlm Unique ID:  9310896     Medline TA:  Strabismus     Country:  England    
Other Details:
Languages:  eng     Pagination:  87-97     Citation Subset:  IM    
Department of Ophthalmology, Erasmus Medical Center, Rotterdam.
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MeSH Terms
Age Factors
Anterior Chamber / pathology*
Child, Preschool
Esotropia / physiopathology*,  surgery*
Follow-Up Studies
Logistic Models
Oculomotor Muscles / surgery
Refraction, Ocular / physiology*
Remission, Spontaneous
Retrospective Studies
Vision, Binocular / physiology*
Erratum In:
Strabismus. 2013 Mar;21(1):56-7

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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