Japanese Journal of Ophthalmology

, Volume 55, Issue 4, pp 383–388

Influence of timing of initial surgery for infantile esotropia on the severity of dissociated vertical deviation

  • Teiji Yagasaki
  • Yoshimi O. Yokoyama
  • Mariko Maeda
Clinical Investigation



The purpose of this study was to clarify whether the timing of initial surgery for infantile esotropia contributes to better sensory outcomes and to the severity of dissociated vertical deviation (DVD).


This retrospective study examined 55 children, aged 8 years and younger, who underwent esotropia surgery. Based on age at the time of the surgery, patients were divided into the very early surgery group (birth to 8 months, N = 14), early surgery group (9–24 months, N = 23) and late surgery group (25 months and older, N = 18). Sensory and motor outcomes of the three groups were statistically evaluated.


No significant differences in the incidences of DVD were noted among the three groups at the final visit. However, all DVDs of the very early surgery group were latent, whereas 38.9% of the DVDs for both near and distance of the late surgery group were manifest. Significant differences were found among the three groups for the proportion of patients with manifest DVD, latent DVD and without DVD, and for the incidence of additional surgery for manifest DVD (p < 0.05, G-test).


Early surgery for infantile esotropia decreases the severity of DVD and lowers the need for an additional operation for DVD.


Dissociated vertical deviation Infantile esotropia Fusion Timing of surgery 


  1. 1.
    Parks MM. Extraocular muscles. In: Tasman W, Jaeger EA, editors. Duane’s clinical ophthalmology, revised ed., vol 1. Philadelphia: Lippincott, Williams & Wilkins; 1998. p. 1–4.Google Scholar
  2. 2.
    Helveston EM. Surgical management of strabismus: an atlas of strabismus surgery. 4th ed. Mosby: St. Louis; 1993.Google Scholar
  3. 3.
    Guyton DL. Dissociated vertical deviation: etiology, mechanism, and associated phenomena. Costenbader lecture. J AAPOS. 2000;4:131–44.PubMedGoogle Scholar
  4. 4.
    Brodsky MC. Dissociated vertical divergence: perceptual correlates of the human dorsal light reflex. Arch Ophthalmol. 2002;120:1174–8.PubMedGoogle Scholar
  5. 5.
    van Rijn LJ, ten Tusscher MP, de Jong I, Hendrikse F. Asymmetrical vertical phorias indicating dissociated vertical deviation in subjects with normal binocular vision. Vision Res. 1998;38:2973–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Worth C. Squint: its causes, pathology, and treatment. 2nd ed. London: John Bale, Sons & Danielsson; 1903.Google Scholar
  7. 7.
    Chavasse FB. Worth’s squint or the binocular reflexes and the treatment of strabismus. 7th ed. London: Bailliere Tindall and Cox; 1939.Google Scholar
  8. 8.
    Ing MR. Early surgical alignment for congenital esotropia. Trans Am Ophthalmol Soc. 1981;79:625–63.PubMedGoogle Scholar
  9. 9.
    Von Noorden GK. A reassessment of infantile esotropia. XLIV Edward Jackson memorial lecture. Am J Ophthalmol. 1988;105:1–10.Google Scholar
  10. 10.
    Helveston EM, Ellis FD, Plager DA, Miller KK. Early surgery for essential infantile esotropia. J Pediatr Ophthalmol Strabismus. 1990;27:115–9.PubMedGoogle Scholar
  11. 11.
    Wright KW, Edelman PM, McVey JH, Terry AP, Lin M. High grade stereo acuity after early surgery for congenital esotropia. Arch Ophthalmol. 1994;112:913–9.PubMedGoogle Scholar
  12. 12.
    Birch E, Fawcett S, Stager D. Why does early surgical alignment improve stereoacuity outcomes in infantile esotropia. J AAPOS. 2000;4:10–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Shirabe H, Mori Y, Dogru M, Yamamoto M. Early surgery for infantile esotropia. Br J Ophthalmol. 2000;84:536–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Ing MR, Okino LM. Outcome study of stereopsis in relation to duration of misalignment in congenital esotropia. J AAPOS. 2002;6:3–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Simonsz HJ, Kolling GH, Unnebrink K. Final report of the early vs. late infantile strabismus surgery study (ELISSS), a controlled, prospective, multicenter study. Strabismus. 2005;13:169–99.PubMedCrossRefGoogle Scholar
  16. 16.
    Birch EE, Stager DR. Long-term motor and sensory outcomes after early surgery for infantile esotropia. J AAPOS. 2006;10:409–13.PubMedCrossRefGoogle Scholar
  17. 17.
    Helveston EM, Neely DF, Stidham DB, Wallace DK, Plager DA, Sprunger DT. Results of early alignment of congenital esotropia. Ophthalmology. 1999;106:1716–26.PubMedCrossRefGoogle Scholar
  18. 18.
    Neely DE, Helveston EM, Thuente DD, Plager DA. Relationship of dissociated vertical deviation and the timing of initial surgery for congenital esotropia. Ophthalmology. 2001;108:487–90.PubMedCrossRefGoogle Scholar
  19. 19.
    Choi RY, Kushner BJ. The accuracy of experienced strabismologists using the Hirschberg and Krimsky tests. Ophthalmology. 1998;105:1301–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Santiago AP, Rosenbaum AL. Dissociated vertical deviation. In: Rosenbaum AL, Santiago AP, editors. Clinical strabismus management. 1st ed. Philadelphia: WB Saunders; 1999. p. 237–47.Google Scholar
  21. 21.
    Fawcett SL, Wang YZ, Birch EE. The critical period for susceptibility of human stereopsis. Invest Ophthalmol Vis Sci. 2005;46:521–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Wright KW. Dissociated vertical deviation and dissociated horizontal deviation. In: Wright KW, Spiegel PH, editors. Pediatric ophthalmology and strabismus. 2nd ed. New York: Springer; 2003. p. 270–4.Google Scholar
  23. 23.
    Arslan U, Atilla H, Erkam N. Dissociated vertical deviation and its relationship with time and type of surgery in infantile esotropia. Br J Ophthalmol. 2010;94:740–2.PubMedCrossRefGoogle Scholar
  24. 24.
    Stevens GT. On double vertical strabismus. Am Oculist Paris. 1895;113:225–32.Google Scholar
  25. 25.
    Guthrie ME, Wright KW. Congenital esotropia. Ophthalmol Clini N Am. 2001;14:419–25.CrossRefGoogle Scholar
  26. 26.
    Wang M, Bedell HE. Asymmetrical vertical phorias in normal subjects: the influence of unbalanced illumination. Strabismus. 2005;13:123–8.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2011

Authors and Affiliations

  • Teiji Yagasaki
    • 1
    • 2
  • Yoshimi O. Yokoyama
    • 2
  • Mariko Maeda
    • 2
  1. 1.Yagasaki Eye ClinicIchinomiyaJapan
  2. 2.Department of OphthalmologySocial Insurance Chukyo HospitalNagoyaJapan

Personalised recommendations