Strabismus Surgery for Esotropia, Down Syndrome and Developmental Delay; Is an Altered Surgical Dose Required? A
Alia Harrison1, Louise Allen1, Anna O'Connor1
1University of Liverpool, GB.
Insights
Children with developmental delay may need adjusted surgical doses for esotropia, unlike those with Down syndrome. Further research is needed for Down syndrome patients regarding surgical adjustments for strabismus.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Genetics
Background:
- Strabismus, particularly esotropia, is prevalent in children with Down syndrome and developmental delay, often necessitating surgical intervention.
- Historical recommendations suggest adjusting surgical doses for these populations due to altered responses.
Purpose of the Study:
- To review existing literature and determine if modified surgical approaches are required for esotropia in children with Down syndrome or developmental delay.
Main Methods:
- A comprehensive literature review was performed using PubMed and Web of Knowledge.
- Inclusion criteria focused on English language papers, with chronological analysis and reference/citation searching.
Main Results:
- In Down syndrome cohorts, non-adjusted surgical doses for esotropia showed success rates of 62.0%-85.7%, with no successful outcomes reported for adjusted doses.
- For developmental delay cohorts, adjusted surgical doses yielded success rates of 37.5%-86.0%, while one study reported a 76.0% success rate with non-adjusted doses.
Conclusions:
- Evidence suggests that individuals with developmental delay may benefit from reduced surgical doses due to an exaggerated surgical effect.
- Current research does not support reduced surgical doses for Down syndrome patients, indicating a need for further investigation.
Background And Purpose:
There is a high rate of strabismus, in particular esotropia, in children with Down syndrome or developmental delay, which frequently requires surgical correction. A paper in 1994 advocated that the surgical dose be adjusted due to an altered response in these children. The aim of this literature review is to evaluate the available evidence to establish whether an altered surgical approach is required in either population.
Methods:
A literature review was conducted using PubMed and Web of Knowledge. Only English language papers were eligible for inclusion. The papers were collated in chronological order for analysis, and their references searched for further relevant papers. Forward citation searches were also undertaken.
Results:
A 2 × 2 comparison is made between publications on Down syndrome (in isolation) and developmental delay populations (including Down syndrome) with adjusted versus non-adjusted surgery. Published surgical success rates on esotropia from unaltered surgical doses range from 62.0%-85.7% (four papers) in the Down syndrome cohort, with none of the adjusted surgeries having a successful outcome. Surgical success rates from adjusted surgical doses in developmental delay cohort range from 37.5%-86.0% (seven papers), with one unadjusted surgical success rate of 76.0%. The results across the studies are summarised in a table and discussed.
Conclusions:
An exaggerated surgical effect in individuals with developmental delay has been reported, and this population may benefit from a reduced surgical dose. Published research does not support giving a reduced surgical dose in individuals with Down syndrome, but more research needs to be done to make a definitive conclusion.
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