# Surgical Outcomes and Predictors of Success in Esotropia: A Five-Year Retrospective Review From a Large UK Tertiary Centre

## TL;DR

This study evaluates esotropia surgery outcomes and finds that older age and higher surgical dose response are linked to better results.

## Contribution

The study identifies age and surgical dose response as predictors of success in esotropia surgery.

## Key findings

- Surgical success at six weeks was achieved in 50% of patients.
- Older age at surgery predicted a higher likelihood of success (OR 1.37).
- Larger preoperative deviation was associated with a higher dose response.

## Abstract

Purpose: To evaluate surgical outcomes and predictors of success in a mixed cohort of patients undergoing esotropia surgery at a large UK tertiary centre.

Methods: This retrospective chart review included all patients who underwent extraocular muscle surgery for esotropia between July 2020 and June 2025. Demographic data, esotropia subtype, visual acuity, preoperative deviation, surgical procedure, total surgical dose, and postoperative deviation at last follow-up were collected. The primary outcome was surgical success at six weeks, defined as postoperative deviation ≤10 prism dioptres (PD). Secondary outcomes included surgical dose response and factors associated with surgical success. Univariate and multivariate analyses were performed.

Results: Seventy patients met the inclusion criteria. Mean age at surgery was 8.0 ± 3.9 years, and mean preoperative deviation was 37.7 ± 13.4 PD. Bilateral medial rectus recession was the most common procedure (81.4%). Surgical success at six weeks was achieved in 50% of patients, with an overcorrection rate of 1.4%. In multivariate analysis, older age at surgery predicted a higher likelihood of success (OR 1.37, p = 0.014). The mean surgical dose response was 2.39 ± 1.95 PD/mm and was significantly higher among successful cases (p < 0.001). Larger preoperative deviation was independently associated with a higher dose response.

Conclusions: In this mixed-aetiology real-world cohort, early surgical success was adequate. Older age and higher surgical dose response were associated with better alignment outcomes, whereas sex, visual acuity, esotropia subtype, and procedure type were not predictive of success.