Different treatments for a squint (deviation of the eye) that occurs within the first six months of life

Infantile esotropia can affect the vision in the eye, the ability to use the two eyes together (binocularity) and also be a cosmetic issue to the child/parents. Treatment includes surgical and non-surgical interventions to reduce the squint and to enhance/aid binocularity in children. This review looks at the various interventions and also the timing of such treatment. The review did not find any randomised trials that compared treatment to another treatment or to no treatment. A large, multi-centre, non-randomised trial found that children operated on earlier had better binocularity at age six compared to the late surgery group. This group had been operated on more frequently however and there was no significant difference in the angle of the squint after surgery in either group. This review does not resolve the controversy regarding the best type of surgery, the value of non-surgical interventions and the optimal timing of either type of intervention. It highlights a need for further research in this area.

Authors' conclusions: 

The main body of literature on interventions for IE are either retrospective studies or prospective cohort studies. It has not been possible through this review to resolve the controversies regarding type of surgery, non-surgical intervention and age of intervention. There is clearly a need for good quality trials to be conducted in these areas to improve the evidence base for the management of IE.

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Background: 

Infantile esotropia (IE) is the inward deviation of the eye. Various aspects of the clinical management of IE are unclear; mainly, the most effective type of intervention and the age at intervention.

Objectives: 

The objective of this review was to assess the effectiveness of various surgical and non-surgical interventions for IE and to determine the significance of age at treatment with respect to outcome.

Search strategy: 

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to June 2013), EMBASE (January 1980 to June 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 10 June 2013. We manually searched the conference proceedings of the European Strabismological Association (ESA) (1975 to 1997, 1999 to 2002), International Strabismological Association (ISA) (1994) and American Academy of Paediatric Ophthalmology and Strabismus meeting (AAPOS) (1995 to 2003). Efforts were made to contact researchers who are active in the field for information about further published or unpublished studies.

Selection criteria: 

We included randomised trials comparing any surgical or non-surgical intervention for infantile esotropia.

Data collection and analysis: 

Each review author independently assessed study abstracts identified from the electronic and manual searches.

Main results: 

No studies were found that met our selection criteria and therefore none were included for analysis.

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