Long-term follow-up of congenital esotropia in a population-based cohort

Purpose: To report the long-term outcomes of a population-based cohort of children diagnosed with congenital esotropia during a 30-year period. Methods: The medical records of all patients diagnosed with congenital esotropia as residents of Olmsted County, MN, from January 1, 1965, through December 31, 1994, were retrospectively reviewed. Results: A total of 130 children were diagnosed during the 30-year period at a median age of 7.4 months with a mean deviation of 30^Δ. During a median follow-up of 11.9 years, 126 patients underwent a mean of 1.8 strabismus surgeries. The risk for undergoing a second surgery was significantly greater in patients with a larger presenting angle (p = 0.017) and a younger age at first surgery (p = 0.006). The Kaplan-Meier rate of having a second surgery was 51% at 10 years and 66% at 20 years. For those with 6 weeks or more of follow-up from the final surgery, last examined at a mean age of 15.1 years, 42 of 94 (45%) were within 8^Δ of orthotropia and 30 of 98 had some level of stereopsis (≤3000 arcsec). Conclusions: In this population-based study of children with congenital esotropia, a second surgery was necessary in half the patients after 10 years and was more likely in those patients with a larger presenting angle and a younger age at first surgery. Approximately half of the patients were within 8^Δ of orthotropia and one-third had measurable stereopsis after a mean of 10.9 years of follow-up.