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Repair of strabismus and binocular fusion in children with cerebral palsy: gross motor function classification scale
Fatema Ghasia1, Janice Brunstrom-Hernandez, Lawrence Tychsen
1Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Insights
Strabismus surgery can successfully restore eye alignment and some binocular vision in children with cerebral palsy (CP). Success rates are similar across CP severity, with earlier surgery improving outcomes.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Rehabilitative Medicine
Background:
- Children with cerebral palsy (CP) are often excluded from strabismus repair studies.
- This study focuses on CP patients to evaluate strabismus surgery outcomes.
Purpose of the Study:
- To determine the success of strabismus repair in restoring eye alignment and fusion in children with cerebral palsy (CP).
- To assess outcomes across different severities of CP, using the Gross Motor Function Classification System (GMFCS).
Main Methods:
- Observational, cross-sectional, prospective study of 50 children with CP.
- Mean age at surgery 3.5 years, mean follow-up 4.1 years.
- Included children with GMFCS levels 1 (least severe) to 5 (most severe).
Main Results:
- Infantile-onset strabismus was predominant (esotropia 54%, exotropia 26%).
- Optimal alignment achieved in 66% of esotropic and 61% of exotropic children after 1.8-2 surgeries.
- Similar alignment success in mild (GMFCS 1-2) vs. severe (GMFCS 3-5) CP.
- 46% gained binocular fusion; quality of fusion better in mild CP.
- Earlier surgery correlated with higher success rates.
Conclusions:
- Restoring binocular alignment and some fusion is achievable in most strabismic children with CP.
- Surgery is a viable option for both mild and severe CP, without significant concerns about futility or reoperation rates.
Purpose:
Children with cerebral palsy (CP) tend to be either excluded from studies of strabismus repair or pooled with children who have other neurologic disorders. The authors limited this study to children with defined CP to determine the success or failure of restoring eye alignment and fusion.
Methods:
An observational, cross-sectional, prospective study was conducted on a representative cohort of 50 children. CP severity ranged from Gross Motor Function Classification System (GMFCS) level 1 (least severe) to 5 (most severe). Mean age at entrance and surgery was 3.5 years, and mean follow-up was 4.1 years (minimum 1 year).
Results:
The predominant form of strabismus was infantile-onset: esotropia in 54%, exotropia in 26%, and dyskinesia in 10%. Sixty-six percent of esotropic children and 61% of exotropic children achieved optimal (microtropic) alignment after an average of 2 and 1.8 surgical procedures, respectively. The likelihood of optimal alignment was similar in children with mild (GMFCS level 1-2) versus severe (GMFCS level 3-5) CP (P = 0.7; χ(2)). Irrespective of GMFCS severity, 46% of children gained binocular fusion/stereopsis, but the quality of fusion gained was greater in children with mild CP (P < 0.05). Earlier surgery was more likely to be successful (P < 0.05).
Conclusions:
Restoration of binocular alignment and a degree of fusion is a realistic goal in the majority of strabismic CP children. Repair may be achieved in children at both the mild and the severe ends of the GMFCS spectrum, without undue concern about treatment futility or excessive reoperation.
