| Predictive value of age, angle, and refraction on rate of reoperation and rate of spontaneous resolution in infantile esotropia. | |
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MedLine Citation:
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PMID: 20843185 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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, www.simonsz.net), 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. |
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Authors:
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H J Simonsz; M J C Eijkemans |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study |
Journal Detail:
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Title: Strabismus Volume: 18 ISSN: 1744-5132 ISO Abbreviation: Strabismus Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-09-16 Completed Date: 2011-03-29 Revised Date: 2013-04-23 |
Medline Journal Info:
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Nlm Unique ID: 9310896 Medline TA: Strabismus Country: England |
Other Details:
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Languages: eng Pagination: 87-97 Citation Subset: IM |
Affiliation:
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Department of Ophthalmology, Erasmus Medical Center, Rotterdam. simonsz@compuserve.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Age Factors Anterior Chamber / pathology* Child Child, Preschool Esotropia / physiopathology*, surgery* Female Follow-Up Studies Humans Infant Logistic Models Male Oculomotor Muscles / surgery Refraction, Ocular / physiology* Remission, Spontaneous Reoperation Retrospective Studies Vision, Binocular / physiology* |
| Comments/Corrections | |
Erratum In:
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Strabismus. 2013 Mar;21(1):56-7 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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