Abstract
Purpose :
To evaluate practice patterns in the treatment of craniosynostosis patients requiring primary craniofacial reconstruction and extraocular muscle surgery (EOM).
Methods :
In a retrospective review, clinical records of all patients who underwent surgical correction of craniosynostosis and were evaluated by an ophthalmology provider at Hershey Medical Center between January 1, 2010 and November 25, 2022 were included.
Results :
There were 106 patients with craniosynostosis that were evaluated by ophthalmology and 34 (32%) were diagnosed with strabismus. Of the 34 patients, there were 14 females (41%) and 20 males (59%) with a median age of 4.5 months (range 0-9 years) at date of first craniofacial evaluation. There were 12 patients with (35%) unicoronal, 10 (29%) bicoronal, 4 (12%) metopic, 2 (6%) sagittal synostosis, and 6 (18%) with synostosis involving multiple sutures. Of the craniosynostosis patients that developed strabismus, 13(38%) were syndromic and 21(62%) were non-syndromic. Fourteen (41%) of the patients with strabismus underwent at least one EOM surgery while 20 (59%) were managed conservatively with patching, glasses, or observation. The average age at primary craniofacial reconstruction was 14.2 months (median 7.5 months, range 2 months – 5.5 years). When indicated, EOM surgery was performed at an average age of 3.8 years (median 3.1 years, range 11 months – 11.3 years). Of the 34 patients with strabismus, 12 (35%) eventually developed all cause amblyopia, and 4 (33%) of these patients developed amblyopia after EOM surgery.
Conclusions :
In this analysis, children with craniosynostosis that subsequently developed strabismus were evaluated by an ophthalmologist at an average age of 2.8 years (median 13.5 months, range 0 - 13.8 years). When surgical intervention for strabismus was indicated, it was performed at an average 2.7 years (median 20 months, range 1 month – 10 years) after primary craniofacial reconstruction. The risk for all-cause amblyopia is high in this population (12 patients, 35%), but the development of strabismic amblyopia can be minimized with early involvement of pediatric ophthalmology.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.