Is Alignment Within 8 Prism Diopters of Orthotropia a Successful Outcome for Infantile Esotropia Surgery?

OBJECTIVE: To determine if there is better long-term motor alignment or sensory outcome 5 years after surgery for infantile esotropia for patients who exhibit any of three categories of alignment 6 months after surgery: orthotropia, up to 8 prism diopters (delta) of esotropia, or up to 8 delta of exotropia. DESIGN: A 15-year prospective study with 5-year outcome determination was conducted in surgically treated esotropic infants. RESULTS: Of 118 patients in the study group, 24 had orthotropia, 84 had up to 8 delta of esotropia, and 10 had up to 8 delta of exotropia 6 months after surgery. The patients who were orthotropic 6 months after surgery were more likely to show good alignment and better binocularity 5 years after surgery than were patients with small-angle esotropia or small-angle exotropia. Patients who were esotropic 6 months after surgery were more likely to have good alignment and binocularity 5 years after surgery than were patients who were exotropic 6 months after surgery. CONCLUSION: Small-angle esotropia, small-angle exotropia, and orthotropia are not equally desirable outcomes after surgery for infantile esotropia. Orthotropia is a decidedly better outcome than a small-angle esotropia, which is preferable to a small-angle exotropia.