Background: Most studies of infantile esotropia concern patients diagnosed in infancy and treated throughout childhood. This prospective study addresses changes in the functional binocular status of older children and adults with previously untreated infantile esotropia, following late surgical realignment.
Subjects and methods: Seventeen patients aged 8 years or more with a history of untreated esotropia occurring within the first 6 months of life were included in this study. All had monocular optokinetic asymmetry, a visual acuity of 20/30 or better in the worse eye, and binocular function assesment preoperatively and postoperatively. All were surgically aligned within 8(Delta) of orthotropia. None had neurologic disease.
Results: Preoperatively, all 17 patients demonstrated a monocular response to Bagolini lenses, while postoperatively 15 (88%) of the 17 demonstrated binocular function with Bagolini lenses (in that they could constantly perceive the major part of both arms of the X generated by the Bagolini lenses) and 13/17 (76%) demonstrated an increase in the binocular field. All 17 had no sensory fusion, either preoperatively or postoperatively, when tested with the Worth 4-Dot test or synoptophore, and no stereopsis with the Titmus stereo test.
Conclusions: Older children and adults with previously untreated infantile esotropia derive some functional benefits following late surgical realignment. The degree of binocular function may be lower than that achieved in patients aligned before 24 months of age.