Comparison of surgical outcomes in classic and looped recession surgery for infantile esotropia

PURPOSE: In the assessment of patients undergoing classic and looped recession surgery for infantile esotropia, an evaluation is performed regarding their demographic characteristics, as well as motor and sensory outcomes. MATERIALS AND METHODS: A retrospective analysis was conducted on the medical records of 46 patients who were diagnosed with infantile esotropia and underwent surgical treatment in the Strabismus Unit of the Department of Ophthalmology at Manisa Celal Bayar University Hospital between January 2005 and December 2021. Patients who underwent either bimedial recession surgery (classic recession group) or suspended bimedial recession surgery (looped recession group) were included in the study. The gender of the cases, cycloplegic refractive values, age at surgery, duration of follow-up, measured degrees of deviation at preoperative, postoperative, and final follow-up examinations, development of fusion and stereopsis, the presence of associated dissociated vertical deviation, nystagmus, and lateral incomitance were recorded. A comparison was made between the classic recession group and the looped recession group. Individuals with postoperative deviation of 10 prism diopters (PD) or less are considered to have achieved a successful surgical outcome. The cases were additionally divided into an early surgical group (prior to the 15th month) and a late surgical group (after the 15th month). These two groups were compared in terms of reoperation rates and stereopsis development. RESULTS: Out of the 46 subjects included in the study, 28 of them (%60,86) were in the classic recession group, while 18 of them (39.14%) were in the loopedrecession group. In the classic recession group, out of the 28 patients, 20 (71.43%) were male, and 8 (28.57%) were female. In the looped recession group, out of the 18 patients, 9 (50%) were male, and 9 (50%) were female. When comparing the groups in terms of refractive values, age at surgery, follow-up durations, postoperative deviation levels, and deviation levels at the final follow-up examination, no statistically significant differences were observed (with p-values of 0.864, 0.434, 0.968, 0.338, and 0.583, respectively). In the classic recession group, the mean preoperative deviation level was found to be 46.61 ± 15.40 prism diopters (PD), while in the looped recession group, it was 62.78 ± 14.06 PD (p=0.01). Reoperation was deemed necessary in 17 of the cases included in the study. In the early surgical group, the number of cases requiring reoperation was 11 (64.70%), while in the late surgical group, the number of cases was 6 (35.29%) (p=0,7). In the early surgical group, fusion development was observed in 9 cases (90%), whereas in the late surgical group, fusion development was seen in only 1 case (10%) (p=0,02).In addition, all six adults in whom stereopsis development was detected belonged to the early surgical group (p=0,01). We identified that early surgical intervention resulted in more successful sensory outcomes, although it was associated with a higher rate of reoperation. CONCLUSION: In cases where surgical treatment is indicated for infantile esotropia, the described looped recession method for large-angle deviations is a surgical approach that can achieve similar rates of motor alignment success without the need for excessive intervention in multiple horizontal muscles. The data obtained from our study were in line with the literature and supported the notion that early surgical intervention in infantile esotropia is associated with satisfactory sensory outcomes. The early surgical correction may have a positive impact on the limited acquisition of binocular functions.