June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Strabismus Associated with Craniosynostosis and related Craniofacial Surgery
Author Affiliations & Notes
  • Yvette Schein
    University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
    Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Jessica Thayer
    Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Brian Forbes
    Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Yinxi Yu
    University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Christopher L Kalmar
    Division of Plastic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Daphna Prat
    Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Karen Revere
    Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Gil Binenbaum
    Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Yvette Schein, None; Jessica Thayer, None; Brian Forbes, None; Yinxi Yu, None; Christopher Kalmar, None; Daphna Prat, None; Karen Revere, None; Gil Binenbaum, None
  • Footnotes
    Support  NIH Grant P30 EY01583-26 and Richard Shafritz Endowed Chair in Ophthalmology Research
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 3331. doi:
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      Yvette Schein, Jessica Thayer, Brian Forbes, Yinxi Yu, Christopher L Kalmar, Daphna Prat, Karen Revere, Gil Binenbaum; Strabismus Associated with Craniosynostosis and related Craniofacial Surgery. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3331.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : We sought to determine prevalence and types of strabismus in children with craniosynostosis, as well as effects of major and minor cranial suture involvement and craniofacial surgery. Limited published data describe these prevalences.

Methods : Retrospective cohort study of children with craniosynostosis over an 11-year period. Primary outcomes were prevalence and types of strabismus overall, among subtypes of craniosynostosis determined by imaging and intraoperative findings, and pre/post craniofacial surgery.

Results : 726 children with craniosynostosis were studied; mean age 2.9 years (SD 3.7), mean follow-up 3 years (SD 3), 37% syndromic/genetic association. 44% had sagittal fusion, 41% coronal, 31% metopic, 11% lambdoid, 9% minor suture(s). 82% had one major suture fused, 17% had 2-4 sutures. 56% underwent craniofacial surgery. Overall, 261 (36%) children had strabismus, of whom 18% had exotropia, 12% esotropia, 11% vertical, 20% inferior oblique overaction. Considering pre-craniofacial-surgery exams, if one major suture was fused, strabismus risk was 15-18%, except for coronal, which was 47%. Strabismus prevalence increased with number of fused major sutures (30% for 1, to 70% for all 4). Craniofacial surgery increased strabismus (26% versus 33%, p=0.03), but some pre-op strabismus resolved postoperatively. Vertical strabismus was associated with unilateral (36%) versus bilateral coronal synostosis (9%, P<0.001). Exotropia was associated with minor suture fusion (32% vs. 16%, p=0.01).

Conclusions : Craniosynostosis carries a 36% risk of strabismus, a 15-fold increase versus the general population, and this risk varies with number and type of sutures involved.

This is a 2021 ARVO Annual Meeting abstract.

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