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Updated: May 1, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Strabismus surgery outcomes in pediatric patients with developmental delay: a meta-analysis and systematic review
Edward Tran1, Monali Malvankar-Mehta2,3, Nirmit Shah4
1Department of Ophthalmology, Schulich School of Medicine and Dentistry, London, ON, Canada.
Insights
Strabismus surgery in children with developmental delays shows significant ocular alignment improvement. However, these children may experience higher overcorrection rates and require more repeat surgeries compared to peers without developmental delays.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Developmental Pediatrics
Background:
- Strabismus management in children with developmental delays is complex due to factors like limited neuroplasticity and poor visual control.
- Outcomes for strabismus surgery in this population are often unpredictable.
Purpose of the Study:
- To evaluate the outcomes of strabismus surgery in children with developmental delays.
- To compare surgical outcomes between children with and without developmental delays.
Main Methods:
- A meta-analysis of eligible studies published before May 28, 2023, was conducted.
- Data were extracted from multiple databases including MEDLINE, EMBASE, and Cochrane Library.
- Fixed-effect and random-effect models were used to analyze surgical dose and post-operative ocular alignment.
Main Results:
- No significant difference in surgical dose was found between children with and without developmental delays.
- Developmentally delayed children showed significant improvement in their angle of deviation post-surgery.
- While undercorrection rates were similar, overcorrection was higher in developmentally delayed children (12% vs. 4.35%).
- Repeat surgeries were more common in developmentally delayed children (23.9% for two, 7.15% for three surgeries).
Conclusions:
- Strabismus surgery can significantly improve ocular alignment in children with developmental delays.
- This population may have increased risks of overcorrection and require more surgical interventions.
- Surgical outcomes, while improved, present unique challenges in this patient group.
Abstract:
Purpose: Strabismus management in developmental-delayed children presents challenges, as outcomes are unpredictable due to factors such as limited neuroplasticity, poor central control, and subnormal binocular potential. This meta-analysis evaluates the outcomes of strabismus surgery in these children. Methods: Eligible studies published before 28 May 2023 were extracted from MEDLINE, EMBASE, CINAHL, Cochrane, PsychINFO, and gray literature. A meta-analysis was performed using STATA 14.0. The comparator group were children without developmental delays who underwent strabismus surgery. Fixed-effect and random-effect models were computed based on heterogeneity. Results: Our meta-analysis included 31 articles, with a total of 3687 subjects. There was no significant difference in the surgical dose for children with developmental delays compared to children without developmental delays (SMD -0.06, 95% CI: [-0.36, 0.23]). Post-operatively, developmentally delayed children had a significant improvement in their angle of deviation (SMD 2.79, 95% CI: [2.50, 3.08]) and could achieve a post-operative angle of deviation similar to children without developmental delays (SMD -0.20, 95% CI: [-0.51, 0.11]). The median rate of undercorrection was similar between developmentally delayed and children without developmental delays, at 20.4% and 20.2%, respectively. For the median rate of overcorrection, developmentally delayed children had a higher rate of 12%, compared to 4.35% in children without developmental delays. For developmentally delayed children, the median incidence is 71.45% for needing one surgery, 23.9% for two surgeries, and 7.15% for three surgeries. Conclusions: Strabismus surgery in developmentally delayed children may have higher rates of overcorrection and may need more repeat operations but could achieve significant improvements in their ocular alignment.
