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Factors associated with strabismus in spina bifida myelomeningocele
Heather A Anderson1, Karla K Stuebing, Ray Buncic
1University of Houston College of Optometry, Houston, TX, USA. handerson@optometry.uh.edu
Insights
Strabismus in spina bifida myelomeningocele (SBM) is linked to lower birth weight, younger gestational age, shunt revisions, and higher spinal lesion levels. These factors, particularly spinal lesion level, offer insights into strabismus development in SBM patients.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Developmental Biology
Background:
- Spina bifida myelomeningocele (SBM) is a complex congenital condition.
- Strabismus is frequently observed in individuals with SBM.
- Previous research often linked strabismus in SBM to hydrocephalus, overlooking other potential contributing factors.
Purpose of the Study:
- To investigate the relationship between strabismus and various clinical factors in children with SBM.
- To identify specific factors beyond hydrocephalus that are associated with strabismus in SBM.
Main Methods:
- An eye examination assessing ocular alignment was conducted on 112 children aged 3-18 with SBM.
- Data collected included gestational age, birth weight, respiratory distress, maternal age, shunt revisions, and spinal lesion level.
- Statistical analyses, including logistic regression and Fisher's exact test, were used to determine associations.
Main Results:
- Forty-two percent of participants with SBM had strabismus.
- Lower birth weight (P = .05) and younger gestational age (P = .01) showed a significant association with strabismus.
- Strabismus was more likely in those with at least one shunt revision (P = .038).
- Higher spinal lesion levels, closer to the brain, were significantly related to increased strabismus likelihood (P = .038).
Conclusions:
- Several factors, including birth weight, gestational age, shunt revisions, and spinal lesion level, are associated with strabismus in SBM.
- While some factors are common to the general population, the link between strabismus and spinal lesion level may be specific to SBM.
- Upper spinal lesions, potentially indicating more severe brain dysmorphology, are linked to a higher prevalence of strabismus in SBM.
Purpose:
Higher prevalence of strabismus in individuals with spina bifida myelomeningocele (SBM) has previously been attributed to hydrocephalus; however, SBM is associated with many other complications. This study investigates the relation between strabismus and other factors in SBM.
Methods:
Children aged 3 to 18 years with SBM (n = 112) received an eye examination including assessment of ocular alignment by cover or Hirschberg test. Gestational age, respiratory distress at birth, birth weight, maternal age at birth, number of shunt revisions, and spinal lesion level were also obtained. The relation between these factors and strabismus was analyzed.
Results:
Forty-two participants had strabismus. Maternal age (P = .4) and respiratory distress (P = .6) were not significantly related to strabismus. Lower birth weight was suggestive of a relation with strabismus (logistic regression, P = .05) and younger gestational age was related to strabismus (logistic regression, P = .01). Participants who had at least one shunt revision were more likely to have strabismus (Fisher's exact test, P = .038). Spinal lesion level was significantly related to strabismus with increased likelihood of strabismus for spinal lesions closer to the brain (Wald chi-square, 1,100 = 4.29, P = .038).
Conclusion:
These findings indicate that several factors are associated with strabismus in SBM. Some of these factors (lower birth weight and younger gestational age) are associated with strabismus in the general population, whereas the association of strabismus and level of spinal lesion may be unique to SBM and may be related to the more severe brain dysmorphology associated with upper level spinal lesions.
