Outcomes of strabismus surgery in patients with cerebral palsy

Purpose: To evaluate the outcomes of strabismus surgery in patients with cerebral palsy (CP) and identify factors influencing surgical success. Methods: A retrospective chart review was conducted at the Ophthalmology Outpatient Clinic of Associação de Assistência à Criança Deficiente in São Paulo, Brazil, including patients with CP who underwent strabismus surgery between January 2016 and December 2022. Patients were divided into two groups based on their preoperative diagnosis of esotropia or exotropia. Surgical success was defined as a deviation ≤ 10 prism diopters (PD) at the final follow-up visit. Patients with <6 months of follow-up were excluded. Results: A total of 83 patients were included: 47 (56.6%) with exotropia and 36 (43.4%) with esotropia. The mean preoperative deviation was 50.5 ± 15.9 PD and 36.3 ± 14.0 PD in the exotropia and esotropia group, respectively (p < .001). Surgical success was achieved in 63.8% of the exotropia group and 47.2% of the esotropia group (p = .078). Exotropia cases exhibited more undercorrection (36.2% vs. 22.2%), whereas overcorrection was seen only in the esotropia group (30.6%). A longer postoperative follow-up (p = .006), younger age at surgery (p = .003), and larger preoperative deviation (p < .001) were associated with poorer surgical outcomes. Conclusions: Strabismus surgery in patients with CP demonstrates moderate success rates, with notable tendency toward postoperative drift, particularly toward divergence. Poorer outcomes were associated with younger age at surgery, larger preoperative deviations, and longer follow-up periods.