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Rates of Reoperation and Abnormal Binocularity Following Strabismus Surgery in Children
Christopher T Leffler1, Kamyar Vaziri2, Stephen G Schwartz2
1Department of Ophthalmology, Virginia Commonwealth University Medical Center, Richmond, Virginia.
Insights
Pediatric strabismus surgery outcomes vary by technique. Younger age, esotropia, hyperopia, and botulinum injections increase risks for abnormal binocularity and reoperation, while adjustable sutures show no reoperation benefit.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Clinical Outcomes Research
Background:
- Strabismus surgery aims to correct eye alignment in children.
- Predicting reoperation and abnormal binocularity is crucial for optimizing surgical outcomes.
- Understanding factors influencing outcomes can guide treatment decisions.
Purpose of the Study:
- To identify predictors of reoperation after pediatric strabismus surgery.
- To determine factors associated with abnormal binocularity (amblyopia, diplopia) post-surgery.
- To compare outcomes across different surgical techniques.
Main Methods:
- Retrospective cross-sectional study of a national insurance database.
- Included children (<18 years) undergoing strabismus procedures (2007-2013).
- Analyzed outcomes of adjustable-suture, fixed-suture, and botulinum toxin injections.
Main Results:
- Reoperation rates: 7.4% (fixed), 9.6% (adjustable), 44.9% (botulinum).
- Younger age (<2 years) correlated with higher reoperation and abnormal binocularity.
- Esotropia, hyperopia, and botulinum injection predicted abnormal binocularity; superior oblique surgery predicted reoperation.
Conclusions:
- Adjustable sutures did not reduce reoperation rates in pediatric strabismus surgery.
- Younger age, specific diagnoses (esotropia, hyperopia), and botulinum toxin injections are risk factors for poor binocularity outcomes.
- Botulinum toxin and superior oblique surgery increased reoperation rates.
Purpose:
To determine predictors of reoperation and abnormal binocularity outcomes (including amblyopia and diplopia) following pediatric strabismus surgery.
Design:
Retrospective cross-sectional study.
Methods:
setting: Review of a national insurance database.
Study Population:
Children under age 18 years having strabismus procedures between 2007 and 2013.
Interventions:
Adjustable- or fixed-suture strabismus surgery, or botulinum toxin injection.
Outcome Measures:
Reoperation or diagnosis of abnormal binocularity in the first postoperative year.
Results:
Of 11 115 children having strabismus procedures, 851 (7.7%) underwent reoperation. The reoperation rate was 7.4% for fixed-suture surgeries, 9.6% for adjustable-suture surgeries (P = .18), and 44.9% for botulinum injections (P < .001). Age under 2 years was associated with higher reoperation and abnormal binocularity rates (P < .001). For horizontal strabismus, the postoperative abnormal binocularity rate was 12.8% for fixed-suture surgery and 26.5% for botulinum injection (P = .005). Reoperation rates tended to be higher with adjustable sutures (odds ratio [OR] 1.69, 95% confidence interval [CI] 0.94-3.03, P = .08) or botulinum toxin injection (OR 10.36, 95% CI 5.75-18.66, P < .001) and lower with 3- or 4-muscle surgery (P = .001). Esotropia, hyperopia, and botulinum injection were independently associated with higher rates of postoperative abnormal binocularity (P ≤ .005). For vertical surgeries, predictors of reoperation were adjustable-suture use (OR 2.51, P = .10) and superior oblique surgery (OR 2.36, P < .001).
Conclusions:
Adjustable sutures were not associated with a lower reoperation rate in children. Younger age, esotropia, hyperopia, and botulinum injection were associated with postoperative abnormal binocularity. Superior oblique surgery and botulinum injection were associated with higher rates of reoperation.
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