Long-Term Motor and Sensory Outcomes of Infantile Esotropia following Bilateral Medial Rectus Recession: A Survival Analysis and Real-World Results.

PURPOSE: To evaluate long-term outcomes of bilateral medial rectus recession in infantile esotropia (IET) using survival analysis of real-world data to identify predictors of surgical failure.

METHODS

This retrospective study included 121 IET patients with ≥12 months of follow-up. Motor success was defined as alignment within ±10 prism diopters at 6 months (early) and final visit (late). Sensory success was defined as binocular single vision (BSV), including fusion with or without stereopsis. Long-term motor stability was evaluated using survival analysis and Cox regression, while sensory outcomes were analyzed using multivariable regression.

RESULTS

Median surgical age was 24 months; the mean follow-up was 77.8 ± 59.6 months. Motor success was 56.2% at 6 months and 52.9% at the final follow-up. Cumulative success declined from 95.9% at 1 year to 54.9% at 10 years (median survival: 130 months). Male sex (P = 0.009), larger initial deviation (P = 0.035), and recession ≥6 mm (P = 0.022) were independently associated with failure, whereas surgical timing within the age range represented in this cohort was not. At the last follow-up, 33.1% of patients were undercorrected and 14.0% overcorrected, with overcorrection more frequent in longer follow-up (P = 0.001). Stereopsis was achieved in 9.3% of patients, and 70.9% of patients demonstrated BSV. Amblyopia independently reduced the likelihood of achieving BSV (odds ratio = 0.26, P = 0.015).

CONCLUSIONS

Long-term motor alignment is maintained in about half of IET patients, though stability declines over time. Male sex, larger deviation, and higher surgical dose predict failure. Peripheral fusion is frequent, fine stereopsis remains rare, and amblyopia adversely affects sensory outcome.