A prospective study of alternating occlusion prior to surgical alignment for infantile esotropia: one-year postoperative motor results.

PURPOSE Alternating occlusion prior to surgical alignment has been suggested by some strabismologists to possibly enhance the treatment of infantile esotropia. This report presents the data for 44 patients prospectively enrolled by random assignment to an alternating occlusion or no occlusion subgroup followed for 1 year postoperatively. METHODS All patients were measured at entry into the study, at the time of surgery, and at 6 weeks and 1 year postoperatively. Alternating occlusion was full-time and symmetric for those with no amblyopia but asymmetric for those with amblyopia. The subgroup that did not receive alternating occlusion had occlusion for amblyopia only. Initial surgeries were performed between the ages of 6 and 13 months. RESULTS The patients, as a whole, showed a significant increase of 9.14 prism diopters when followed for a mean of 4.2 months prior to initial surgery (P < .00027). Seventy-five percent of all patients were aligned by the initial surgery. Ninety-one percent of those patients aligned at 6 weeks were also aligned at the 1-year postoperative date. The results were similar for both the control group and the patients treated with alternating occlusion. CONCLUSION In our sample of patients, alternating occlusion does not detectably alter the increase in angle of deviation between the dates of entry and the date of the initial surgical alignment procedure, nor does it influence the postoperative alignment at 6 weeks or at 1 year.