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Systemic evaluation of the risk of reoperations in pediatric populations with exotropia and esotropia: nested
Ju-Yeun Lee1, Seong Jae Kim2,3,4, Hyuna Kim5
1Department of Ophthalmology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea.
Insights
Pediatric strabismus surgery reoperation risk is higher in younger children and those receiving unilateral procedures. Early intervention under age three, especially unilateral surgery, significantly increases reoperation rates for both exotropia and esotropia.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Public Health
Background:
- Strabismus surgery aims to correct eye alignment but reoperations are common in pediatric cases.
- Identifying risk factors for pediatric strabismus reoperation is crucial for improving surgical outcomes.
Purpose of the Study:
- To evaluate the risk of reoperations following initial strabismus surgery in children.
- To identify specific patient groups at higher risk for strabismus reoperation.
Main Methods:
- A nationwide population-based study utilizing the Korean National Health Claims Database (2008-2020).
- Inclusion of 24,816 pediatric patients (≤9 years) who underwent initial surgery for exotropia or esotropia.
- Conditional logistic regression analysis to determine odds ratios (OR) for reoperation risk factors.
Main Results:
- Cumulative reoperation incidence was 843/10,000 for exotropia and 1559/10,000 for esotropia.
- Younger age (under 3 years) significantly increased reoperation risk (OR 4.26 for exotropia, OR 6.57 for esotropia).
- Unilateral surgery elevated reoperation risk (OR 6.49 for exotropia, OR 7.20 for esotropia) compared to bilateral surgery.
Conclusions:
- Younger children, particularly those under three years old, face a substantially higher risk of strabismus reoperation.
- Unilateral strabismus surgery is a significant risk factor for reoperation in both exotropia and esotropia.
- Clinical practice should prioritize careful consideration for very young children and those undergoing unilateral initial surgical interventions for strabismus.
Abstract:
The study aimed to assess the risk of reoperations for strabismus in the pediatric population and to identify high-risk groups. This was a nationwide population-based study that used data from the Korean National Health Claims Database from 2008 to 2020. Two major cohorts were established based on initial strabismus: age-, sex-, and recruitment year-matched controls were randomly selected. Patients aged ≤ 9 years who underwent initial strabismus surgery for exotropia and esotropia were included, resulting in a total of 24,816 patients included to this study. The cumulative incidence of reoperations was 843 per 10,000 persons for exotropia, 1559 per 10,000 persons for esotropia. To assess the significant exposure factors, conditional logistic regression was performed to obtain odds ratio (OR) in each cohort. In patients with exotropia, the OR of reoperations was 4.26 times higher when the initial surgery is performed at younger age (earlier than 3-year-old) and 6.49 times higher when only one eye underwent than two eye. Similarly, in patients with esotropia, younger age (6.57 times) and unilateral surgery (7.20 times) were identified as common factors that increase the risk of reoperations. Based on the findings, special attention is recommended for patients younger than 3 years, especially those performed unilateral surgery as initial intervention in practical settings.
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