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F. F. Ghasia, J. Brunstrom, L. Tychsen; Does Strabismus Surgery Improve Functional Outcomes in Children With Cerebral Palsy? Gross Motor Function Classification Scale. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1994.
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© ARVO (1962-2015); The Authors (2016-present)
To determine binocular sensory and motor outcomes after strabismus surgery in children with cerebral palsy (CP).
A cross-sectional observational study was conducted on 50 children whose CP severity spanned milder (level 1-2) to severe (level 3-5) using the standardized Gross Motor Function Classification System. Optimal motor outcome was defined as 8 PD or less deviation (microtropia) 1 yr post-surgery; sensory outcome was defined as restoration of fusion or stereopsis. Mean age = 3.5 yrs; mean follow-up = 4.1 yrs. Across GMFCS levels children did not differ in gestational age, examination age, preoperative angle or follow-up period (ANOVA p=0.9, p=0.23, p=0.53 respectively).
Children with mild CP achieved a 2.6x greater rate of optimal motor outcome and 3.1x greater stereopsis outcome compared to children with severe CP (50% vs. 19% and 25% vs. 8%). Gain of binocularity was 1.7x greater in children with primary ET (63%) versus primary XT (37%). Outcomes did not differ in children with stable vs. variable-angle preoperative deviation (chi sqr p=0.5). In primary ET children, 38% had optimal motor outcome after 1 surgery and 71% after 2 surgeries. 42% of primary ET children developed a secondary macro XT after 1 surgery, which responded favorably to a 2nd surgery. Shorter duration of strabismus before surgery 1 was associated with better motor outcome [2.6 yrs vs. 4.3 yrs in suboptimal-macrotropia outcome (p=0.05)] and gain in binocularity [2.1 yrs vs. 4.8 yrs (p=0.05)]. Children with dyskinetic strabismus (variable ET/XT) did not achieve optimal motor outcome or gain in binocularity.
Children with milder CP, primary ET and earlier treatment benefit substantially from strabismus surgery. Variable deviation and secondary XT is common, but should not deter earlier treatment.
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