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Outcomes of strabismus surgery for esotropia in children with Down syndrome compared with matched controls
W Walker Motley1, Andrew T Melson, Michael E Gray
1Cincinnati Children’s Hospital Medical Center, Division of Pediatric Ophthalmology, 3333 Burnet Avenue, MLC 4008, Cincinnati, OH 45229, USA. william.motley@cchmc.org
Insights
Standard surgical dosages for strabismus correction, specifically bilateral medial rectus recession, are effective for children with Down syndrome (DS). This study found no significant differences in surgical outcomes or dosages between children with DS and controls.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Genetics
Background:
- Strabismus surgery dosages in children with neurodevelopmental disorders remain controversial.
- Limited data exist on the surgical outcomes for individuals with Down syndrome (DS).
Purpose of the Study:
- To compare surgical outcomes and dosages for strabismus surgery in children with Down syndrome (DS) versus controls.
- To determine if standard surgical dosages for bilateral medial rectus recession need modification in DS patients.
Main Methods:
- Retrospective case-control study matching 16 children with DS who underwent bilateral medial rectus recession with 16 control patients.
- Comparison of surgical dosages and esotropia angles (preoperative, 4-month, and 24-month postoperative) using a random coefficients model.
Main Results:
- No significant difference in surgical dosages between the DS group (median 4.4 mm) and the control group (median 4.5 mm).
- No significant difference in mean esotropia angles at 4 months (DS: 3.15 PD, Control: 2.66 PD) or 24 months (DS: 7.09 PD, Control: 6.60 PD) post-surgery.
- Preoperative esotropia was comparable between groups (DS: 28.4 PD, Control: 27.9 PD).
Conclusions:
- Standard bilateral medial rectus recession surgical dosages are appropriate for children with Down syndrome.
- Surgical outcomes for strabismus in children with DS are comparable to those without DS when using standard dosages.
Purpose:
Strabismus surgery dosages used in children with various neurodevelopmental disorders have been the subject of controversy. Few data have been reported regarding surgical results in individuals with Down syndrome (DS).
Methods:
A retrospective, case-control study was performed in which children with DS and previous bilateral medial rectus recession surgery were matched with similar control patients without DS. Surgical results were compared using a random coefficients model for repeated measurements for each group.
Results:
Sixteen patients with DS were matched with 16 control patients. Mean preoperative esotropia was 28.4 prism diopters (PD) in the DS group and 27.9 PD in the control group. No significant difference was found in surgical dosages between the two groups (P = .2402). Median surgical dosage was 4.4 mm in the DS group and 4.5 mm in the control group. Preoperative and 4-month and 24-month postoperative mean angles of esotropia were not different between groups (P = .8050). The 4-month postoperative mean angles of esotropia for the DS and control groups were 3.15 and 2.66 PD, respectively. The 24-month mean angles of esotropia for the DS and control groups were 7.09 and 6.60 PD, respectively.
Conclusion:
Standard bilateral medial rectus recession surgical dosages need not be modified for individuals with DS.
