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Esotropia Surgery Considering the Angle under General Anesthesia

ABSTRACT Purpose: To compare the amount of esotropia corrected by surgery under general anesthesia and in a conscious state in esotropia surgery. Methods: The charts of 42 patients who underwent surgery under general anesthesia for correction of esotropia were reviewed. Angle of deviation was measured by the alternate prism cover test in awakened state one day before and after surgery. Under general anesthesia, angle of deviation was measured by Hirschberg or Krimsky test in 5 prism diopters (PD) scale 30 minutes after induction and at the end of the surgery. The amount of the angle of esodeviation corrected by surgery measured in awakened state (A-correction) and under general anesthesia (G-correction) was compared and analyzed to identify significant differences. Results: The median age was 4.0 years and the median preoperative esodeviation angle was 30.0 PD. The median amount of G-correction of 30.0 PD was significantly different compared with that of A-correction at postoperative day one (p=0.003). However, differences between A-correction and G-correction were not evident at postoperative one week, one month, and final follow-up examination (p= 0.191, 0.215, and 0.396, respectively). Conclusions: Esotropia in A-correction was comparable to that in G-correction only at postoperative day one. These results suggest that it is desirable to perform esotropia surgery according to the initial surgical plan of awakened state regardless of the divergence of eye position. When in doubt, it could be useful to confirm whether the actual amount of surgical correction under general anesthesia is consistent with the plan and modifying the surgical dose nomogram.