Nelson: The first patient is a 3-year-old boy with cerebral palsy and prematurity with 35 prism diopters of esotropia, minimal hyperopia, and visual acuity of 20/30 in each eye by isolated pictures. How would you manage his esotropia? Guo: Because the hyperopia is minimal, glasses would be unlikely to correct 35 prism diopters of esotropia. His visual acuity is 20/30 and equal in both eyes. I would consider bilateral medial rectus muscle recessions. For children with cerebral palsy, I would remeasure the angle of deviation on at least two separate visits, making sure the angle of esotropia is consistent at 35 prism diopters before planning the surgery because the angle of strabismus in children with cerebral palsy may be variable. I would also perform a lesser amount of muscle surgery than the standard amount because postoperative overcorrection is not uncommon in children with cerebral palsy.
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