Outcomes of strabismus surgery in patients with Down syndrome

This study aimed to evaluate the outcomes of strabismus surgical correction in patients with Down syndrome.

We conducted a retrospective chart review of patients with Down syndrome who underwent strabismus surgery between January 1997 and May 2024 at an Ophthalmology Outpatient Clinic in São Paulo, Brazil. The data collected included age, sex, medical and ocular history, surgical details, and follow-up outcomes. The patients were categorized by strabismus type into esotropia, fourth nerve palsy, and mixed groups. Surgical success was defined as final alignment within 10∆ of orthotropia and, where applicable, whether there was resolution of abnormal head posture of ocular origin. Patients with postoperative follow-up <6 months were excluded.

A total of 37 patients (21 females) were included. Of these, 22 (59.5%) were in the esotropia group, 10 (27.0%) in the fourth nerve palsy group, and 5 (13.5%) in the mixed group. The surgical success rate in the esotropia group was 86.4%, with a mean preoperative deviation of 35.2 (± 6.5)∆, and mean surgical correction of 30.1 (± 10.4)∆. The success rate in the fourth nerve palsy group was 40.0%, with a mean preoperative deviation of 10.4 (± 4.3)∆. Overall, success was achieved with a single surgical procedure in 73.0% of the sample. No significant associations were found between surgical success and the clinical and demographic variables, including sex, age at surgery, oblique muscle overaction, pattern strabismus, visual acuity, amblyopia, preoperative deviation, or postoperative follow-up duration (p>0.05).

When standard surgical tables are applied, strabismus surgery in patients with Down syndrome appears to be safe and effective. We found high success rates, particularly among patients with esotropia. We observed no tendencies toward overor under-correction. These findings support the use of conventional surgical protocols with this patient population.