Surgical outcomes and observation in exotropia cerebral palsy children with cortical visual impairment

Area of Science:

• Ophthalmology
• Pediatric Neurology
• Neuroscience

Background:

• Cortical visual impairment (CVI) is a leading cause of vision loss in children with cerebral palsy (CP).
• Exotropia is the most common form of strabismus observed in pediatric patients with CP.

Purpose of the Study:

• To evaluate the surgical outcomes of strabismus correction in pediatric patients diagnosed with both CP and CVI.
• To assess the impact of strabismus surgery on visual function, specifically contrast sensitivity, in this patient population.

Main Methods:

• Retrospective analysis of medical records from May 2017 to January 2022.
• Inclusion criteria: pediatric patients with CP and CVI, normal intelligence, and diagnosed exotropia.
• Surgical procedures included bilateral lateral rectus recession, with optional medial rectus resection or inferior oblique transposition, performed under general anesthesia. Pre- and post-operative strabismus measurements using prism tests and contrast sensitivity testing (CST) at five spatial frequencies were conducted.

Main Results:

• Thirty-eight patients (age 5-12 years) with CP and CVI underwent strabismus surgery.
• Significant reduction in exotropia was observed, with pre-operative deviation ranging from -30 to -140 prism diopters (PD) and post-operative deviation from 0 to -15 PD.
• Contrast sensitivity testing showed statistically significant improvements at all spatial frequencies post-surgery, particularly at higher frequencies (p < 0.05).

Conclusions:

• Strabismus surgery provides stable and effective correction for exotropia in children with CP and CVI.
• Monocular contrast sensitivity demonstrates significant improvement across all spatial frequency levels following surgical intervention.