Optimal Timing of Surgical Correction for Congenital Esotropia: A Retrospective Cohort Analysis of 86 Patients

Background The timing of surgical intervention for congenital esotropia is crucial for the restoration of binocular vision. Published data provide diverse recommendations, most frequently indicating an optimal age for the first surgery before 24 months, with some authors advocating intervention before one year of age. The goal of early surgery is to maximize the potential for normal binocular development. However, very early operations (6–12 months) raise concerns about technical difficulty, anesthetic safety, and healthcare system constraints. This study aimed to determine whether surgery performed between 12 and 18 months yields better functional and anatomical outcomes compared with other age groups. Methods We conducted a retrospective cohort analysis of 86 patients with congenital esotropia operated between January 2010 and December 2021. Patients were categorized by age at first surgery into four groups: < 12 months, 12–18 months, 18–24 months, and > 24 months. The primary outcome was the degree of binocular function; the secondary outcome was residual horizontal deviation. Statistical analyses included Kruskal–Wallis, Mann–Whitney U tests with Bonferroni correction, Spearman correlation, and ordinal logistic regression. Results The group operated at 12–18 months achieved the highest mean level of binocular function and the highest proportion of patients with stereopsis (16.7%). Age at surgery and the number of procedures were significant predictors of outcome (p < 0.05). Poorer results in the < 12 months group may partly reflect a higher prevalence of the cross-fixation subtype. Conclusion Based on our findings, surgery for congenital esotropia performed between 12 and 18 months of age provides the optimal balance between functional and anatomical outcomes and practical feasibility within real-world clinical settings.