Improving ophthalmic outcomes in children with unilateral coronal synostosis by treatment with endoscopic strip craniectomy and helmet therapy rather than fronto-orbital advancement.

Abstract

PURPOSE:

To compare long-term ophthalmic outcomes in infants treated for unilateral coronal synostosis (UCS) by endoscopic strip craniectomy (ESC) and helmet therapy with those treated by fronto-orbital advancement (FOA).

METHODS:

Consecutive patients with UCS, uncomplicated by other suture synostosis, were identified by a retrospective review of medical records. Assessment of presence of amblyopia, cycloplegic refraction, strabismus, and strabismus surgical intervention at all visits was recorded.

RESULTS:

Between 2004 and 2010, 22 patients were treated by FOA (mean follow-up, 21.5 months) and 21 patients with ESC and helmet therapy (mean follow-up, 23.5 months). The mean aniso-astigmatism was equal; however, the SD was greater for those treated by FOA (P < 0.05). A more severe pattern of strabismus developed in those treated by FOA (P < 0.0001). Those treated by FOA were more likely to have amblyopia (P = 0.0015) and to undergo surgical correction of their strabismus (odds ratio, 6.3:1).

CONCLUSIONS:

Children with UCS treated with ESC and helmeting had less severe overelevation in adduction, amblyopia, extremes of astigmatism, and less need for strabismus surgery than those treated by FOA. Although the reason for these more favorable outcomes remains uncertain, we speculate that the earlier timing of ESC or differences in the anatomical changes resulting from the two procedures may play a role.

• Authors: Sarah MacKinnon, Mark R Proctor, Gary F Rogers, John G Meara, Sarah Whitecross, Linda R Dagi
• Journal: Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus (J AAPOS) Vol. 17 Issue 3 Pg. 259-65 (Jun 2013) ISSN: 1528-3933 [Electronic] United States
• PMID: 23791406 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

Topics

• Amblyopia (etiology)
• Cranial Sutures (diagnostic imaging, surgery)
• Craniosynostoses (diagnostic imaging, surgery)
• Craniotomy (methods)
• Endoscopy
• Eye Movements (physiology)
• Follow-Up Studies
• Head Protective Devices
• Humans
• Infant
• Ophthalmologic Surgical Procedures
• Postoperative Complications
• Retrospective Studies
• Strabismus (etiology)
• Tomography, X-Ray Computed
• Treatment Outcome
• Vision, Binocular (physiology)