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Surgical treatment and muscle protein analysis of V-pattern exotropia in craniosynostosis
Qingyu Liu1, Yuan Li1, Siying Wang1
1Department of Ophthalmology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Insights
Children with craniosynostosis exhibit larger V-pattern exotropia and deviations. Their thinner, weaker extraocular muscles require more surgical recession for correction.
Area of Science:
- Ophthalmology
- Genetics
- Pediatric Surgery
Background:
- V-pattern exotropia is a common strabismus with specific clinical characteristics.
- Craniosynostosis, a premature fusion of skull sutures, can be associated with various craniofacial abnormalities, potentially impacting ocular alignment.
Purpose of the Study:
- To compare V-pattern exotropia characteristics between children with craniosynostosis and healthy controls.
- To investigate potential differences in extraocular muscle (EOM) structure and protein expression in craniosynostosis.
Main Methods:
- Comparative study including 19 children with craniosynostosis and 20 controls.
- Comprehensive ocular examinations, strabismus surgery, and analysis of EOM samples.
- Proteomic analysis to identify differentially expressed proteins in EOMs.
Main Results:
- Craniosynostosis group showed larger deviations, increased V-pattern, and more severe inferior oblique overaction.
- Surgical recession and anterior transposition of EOMs differed significantly between groups.
- Abnormalities in EOMs were found in 32% of craniosynostosis patients versus 5% of controls.
- 40 differentially expressed proteins were identified, with increased collagen proteins and decreased tropomodulin noted.
Conclusions:
- Craniosynostosis is associated with more significant V-pattern exotropia and EOM abnormalities.
- Thinner, weaker EOMs in craniosynostosis necessitate adjusted surgical approaches.
- Altered protein expression, particularly involving collagen and tropomodulin, may underlie EOM dysfunction in craniosynostosis.
Abstract:
The purpose of this study was to compare the differences of V-pattern exotropia in craniosynostosis and normal children. 39 children were included in this study, 19 craniosynostosis and 20 children in control group. They underwent comprehensive ocular examinations and received strabismus surgery. The extraocular muscle samples were analysed. Compared with the control group, craniosynostosis group had larger deviation in primary and up gaze, larger V pattern, and more severe inferior oblique overaction. For 20-40, and 50-60 prism diopter exotropia, the lateral recession in the craniosynostosis group was larger than that in the control group, 7.13 ± 0.44 mm vs 6.71 ± 0.47 mm, 8.90 ± 0.21 mm vs 7.75 ± 0.46 mm (p = 0.025, 0.000). The anterior transposition of craniosynostosis group was more anterior than that of control group, posterior 1.03 ± 1.24 vs 2.68 ± 0.94 mm (p = 0.000). Compared with the control group, the extraocular muscle abnormality in craniosynostosis was significant, 32% vs 5% (p = 0.031). There were 40 proteins in craniosynostosis group, which were different from those in control group. A larger V pattern and larger deviation is common in craniosynostosis children. For the same PD of deviation, it usually needs more recession in craniosynostosis because of the thinner and weaker extraocular muscles. Collagen related proteins were increased in craniosynostosis, and decreased contraction related protein tropomodulin might play key role for the weakness of EOMs.
