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Interventions for infantile esotropiaElliott S, Shafiq A
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SummaryDifferent treatments for a squint (deviation of the eye) that occurs within the first six months of lifeInfantile 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 controlled trails 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.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
January 24. 2005 AbstractBackgroundVarious aspects of the clinical management of infantile esotropia (IE) are unclear - mainly, the most effective type of intervention and the age at intervention. ObjectivesThe 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 strategyWe searched for trials on the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966 to September 2008), EMBASE (January 1980 to September 2008) and LILACS (January 1982 to September 2008). 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 criteriaRandomised trials comparing any surgical or non-surgical intervention for infantile esotropia. Data collection and analysisEach review author independently assessed study abstracts identified from the electronic and manual searches. Main resultsNo studies were found that met our selection criteria and therefore none were included for analysis. Authors' conclusionsThe 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. |