Incidence of Strabismus in Childhood Glaucoma

To evaluate the cumulative incidence of strabismus in childhood glaucoma and compare its risk to that in healthy controls.

A retrospective clinical cohort study.

Childhood glaucoma patients aged ≤18 years from the TriNetX US Collaborative Network.

Patients were identified using the International Classification of Diseases Ninth and 10th Revision codes. The primary study group included childhood glaucoma patients aged ≤18 years, while the control group consisted of healthy children with no history of ocular disorders. We analyzed the cumulative incidence of strabismus in both primary and secondary glaucoma. Propensity score matching (PSM) was used to compare the risk of strabismus between glaucoma and control groups. A Cox proportional hazards model was employed to identify predictors of strabismus among children with glaucoma.

The primary outcome was the cumulative incidence of strabismus at 1 and 5 years after glaucoma diagnosis. The secondary outcomes included (1) comparative risk of strabismus between glaucoma and control groups, (2) evaluating the rates of strabismus surgery in the glaucoma cohort, and (3) identifying the risk factors associated with strabismus development in the glaucoma group.

The study group included 12 637 patients, with a mean age at glaucoma diagnosis of 3.81 ± 4.44 years in the primary glaucoma group and 5.18 ± 4.40 years for the secondary glaucoma group. The cumulative incidence of strabismus in primary glaucoma was 9.19% at 1 year and 18.89% at 5 years. In secondary glaucoma, the cumulative incidence was 20.40% at 1 year and 31.39% at 5 years. After PSM, the 5-year risk of strabismus was significantly higher in the glaucoma group compared with controls (adjusted hazard ratio [aHR]: 7.95; 95% confidence interval [CI]: 5.67-11.14; P <0.01 for primary glaucoma and aHR: 14.51; 95% CI: 12.59-16.72; P <0.01 for secondary childhood glaucoma). Risk factors for strabismus development in the glaucoma group included younger age at secondary glaucoma diagnosis, nystagmus, and amblyopia.

Childhood glaucoma is associated with a significantly increased risk of developing strabismus compared with healthy controls. Within the glaucoma group, younger age (in secondary glaucoma), nystagmus, amblyopia, and glaucoma surgery were all associated with an increased risk of strabismus.

The authors have no proprietary or commercial interest in any materials discussed in this article.