Abstract
Purpose :
We sought to determine rates of reoperation following pediatric strabismus surgery. Detailed large-scale patient-level data are limited in the literature.
Methods :
Retrospective cohort study of children under age 18 years who underwent eye muscle surgery at CHOP from 2009 to 2021. Primary outcomes were risk of reoperation based on survival analysis, overall and stratified by type (e.g., esotropia, exotropia, incomitant, vertical, nystagmus). Age at presentation and surgery, laterality, adjustable suture use, and number of muscles were evaluated as risk factors in multivariable Cox regression analysis.
Results :
2699 children underwent eye muscle surgery at mean age 4.6 (SD 3.3) years, mean follow-up 2.5 years. Overall, 1-, 3-, 5-, and 8-year estimates for cumulative reoperation rate were 8% (95% CI 7-9%), 20% (95% CI 18-23%), 28% (95% CI 25-31%), and 42% (95% CI 38-47%) respectively, with a mean 1.14 (0.42) reoperations and mean 2.2 (2.0) years between initial surgery and first reoperation. Patients with incomitant strabismus had the highest cumulative reoperation rate after 8 years (53%, 95% CI 39-68%), while other types did not differ significantly (37-44% after 8 years). Significant risk factors for reoperation included younger age at presentation (Hazard Ratio HR=1.48, 95% CI 1.05-2.11 for 2 years old or younger versus greater than 6 years) or at initial surgery (HR=1.74, 95% CI 1.26-2.40).
Conclusions :
In the first year following eye muscle surgery, estimated reoperation is approximately 8%, rising over time with prolonged follow-up to 42% after 8 years. These data are helpful in clinical practice for managing parents' expectations for repeat surgery.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.