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Adam L Carrera, Miriam Di Menna, Mary Ellen Hoehn; Post-operative outcomes in pediatric patients with strabismic amblyopia unresponsive to therapy. Invest. Ophthalmol. Vis. Sci. 2020;61(7):504.
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© ARVO (1962-2015); The Authors (2016-present)
It has been well established that post-surgical motor/sensory outcomes are similar in patients with fully treated strabismic amblyopia versus those who have been incompletely treated pre-operatively. To our knowledge, no study has reviewed surgical outcomes in patients unresponsive to therapy. We have also reviewed pre-operative variables to determine if there were significant predictors for improved vision or alignment (± 10 prism diopters of orthophoria).
Following IRB approval, a group of pediatric patients (N=45) with strabismic amblyopia unresponsive to therapy (at least 6 weeks) were retrospectively reviewed. Post-operative vision in amblyopic eye and ocular alignment at final visit (mean follow up 4.15 years) were outcomes of interest. These outcomes and pre-operative variables were compared for statistically significant relationships. The following pre-operative variables were observed: first visit vision in amblyopic eye, first visit horizontal misalignment, length of amblyopia treatment, reported compliance, length of follow up, age at time of surgery, gender, and ethnicity.
Visual acuity in amblyopic eyes at first and final visit were closely related (r=0.765, p<.001). On average, vision in the amblyopic eye at final visit was slightly improved compared to pre-operative vision (0.11 logMAR decrease, p<0.004). Mean ocular misalignment at final visit was 11.62 prism diopters (PD) with 24 patients (53.3%) having <10 PD of deviation. Neither visual acuity or misalignment at first visit had a significant association with final visit alignment outcomes. No other pre-operative variable we studied revealed a statistically significant strong association (r>0.5) with vision or alignment at final visit.
Our results rshowed >50% of patients were within 10 PD of orthophoria after surgery but no pre-operative variables were predictive. Visual acuity had a mild but significant improvement following surgery. Further prospective studies with larger sample sizes may be needed in order to identify variables that can predict improved surgical outcomes in patients with strabismic amblyopia unresponsive to therapy.
This is a 2020 ARVO Annual Meeting abstract.
Association of secondary predictors and post operative outcomes. Relationships with significance are indicated by red boxes.
Association of primary predictors and post operative outcomes. Relationships with significance are indicated by red boxes.
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