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Laura Kueny, Heather de Beaufort; Timing of Congenital Ptosis Repair in Relation to the Development of Strabismus. Invest. Ophthalmol. Vis. Sci. 2018;59(9):90.
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© ARVO (1962-2015); The Authors (2016-present)
In the general population strabismus has a known prevalence of 1-5% . However in the subset of patients that have childhood ptosis the prevalence of strabismus has been reported to be as high as 20%. We performed a retrospective chart review to identify the timing of repair for unilateral congenital ptosis that decreases the risk of subsequent development of strabismus.
Patients that underwent congenital ptosis repair at Children’s National Medical Center in the past 10 years were identified by CPT code. Children were included in the study if they had surgery performed before 1.5 years of age, were orthophoric prior to ptosis repair, and were followed post-operatively for at least 2 years. Patients were excluded if there was ophthalmologic pathology in addition to ptosis at the time of presentation. Patients with any coinciding neurological disease were noted and included in the analysis. The data was then divided into groups by age of congenital ptosis repair including 0-4 months (group 1), >4 to <7 months (group 2) , >7 months to <1 year (group 3), and > 1 year (group 4). The study looked at the development of strabismus and amblyopia in each age group.
40 total patients were identified that met criteria for the study. 6 patients (15%) developed strabismus after surgery, and 22 patients (55%) developed amblyopia before or after surgery. 0 patients in group 1 developed strabismus, 3 patients in group 2 (27.3%), 0 patients in group 3, and 3 patients in group 4 (21.4%), coinciding with a p value of 0.93. Of the patients that developed strabismus, one patient in group 2 and one patient in group 4 had coinciding neurological disorders. There was a higher incidence of refractive amblyopia in patients that had congenital ptosis repair after 4 months of age, 0 patients in group 1 (0%), 4 patients in group 2 (66.7%), 2 patients in group 3 (33.3%), and 6 patients in group 3 (75%), coinciding with a p value of 0.86.
15% of patients with congenital ptosis subsequently developed strabismus. There was an increased incidence of strabismus and refractive amblyopia in children with congenital ptosis repair between 4-7 months and >1 year. There was no statistically significant difference between age of congenital ptosis repair and development of strabismus, or development of refractive amblyopia, however this was likely due to the small sample size of the study.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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