Related Experiment Video
Updated: Aug 25, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Outcomes of Strabismus Procedures in Children with Perinatal Brain Injury
Yi Zhou1, Esha Prakash2, Eric D Gaier3
1Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts.
Insights
Children with perinatal brain injury have poorer long-term strabismus surgery outcomes compared to controls. This suggests a need for tailored counseling and further research into adjusted treatment dosing for this population.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Strabismus Surgery Outcomes
Background:
- Perinatal intracranial injuries can impact neurodevelopment and potentially affect outcomes of strabismus surgery.
- Strabismus is a common condition in children, requiring effective treatment strategies.
Purpose of the Study:
- To compare the long-term success rates of strabismus procedures in children with and without a history of perinatal intracranial injuries.
- To identify factors influencing strabismus treatment success in children with brain injuries.
Main Methods:
- Retrospective cohort study comparing 108 children with strabismus and perinatal brain injury to 108 matched controls.
- Patients underwent incisional surgery, botulinum toxin injection, or augmented surgery with at least two years of follow-up.
- Outcomes assessed included two-year motor success and general motor-sensory success without retreatment.
Main Results:
- Children with perinatal brain injury showed significantly lower two-year motor success (43.5% vs 65.7%) and general motor-sensory success (47.2% vs 69.4%) compared to controls.
- Postoperative drift was greater in the brain-injury cohort, with undercorrection being the predominant cause of failure.
- Larger preoperative deviation was associated with lower success, particularly in esotropia cases.
Conclusions:
- Perinatal brain injury is associated with reduced long-term success in strabismus treatment, primarily due to undercorrection.
- Preoperative counseling should be tailored for these patients, considering the higher likelihood of secondary interventions.
- Further prospective studies are needed to explore adjusted treatment dosing strategies for children with perinatal brain injuries.
Purpose:
To evaluate the long-term success rates of strabismus procedures in children with a history of perinatal intracranial injuries compared to matched controls.
Design:
Retrospective clinical cohort study.
Subjects:
108 patients with strabismus (84 esotropia, 24 exotropia) and perinatal brain injury. Controls (108 without brain injuries) were matched 1:1 by horizontal deviation type, age at intervention, and preoperative deviation magnitude.
Methods:
Patients underwent incisional surgery, botulinum toxin injection, or botulinum toxin-augmented surgery with at least two years of follow-up.
Main Outcome Measures:
Two-year motor success (horizontal deviation ≤10 prism diopters) and general motor-sensory success (motor success or fine stereopsis ≤100 arcseconds), without requiring retreatment.
Results:
At 3-6 months, success did not differ significantly (52.9% vs 67.3%; P=.098). At 2 years, motor success was lower in the brain-injury cohort overall (43.5% vs 65.7%; OR=0.31, 95% CI, 0.16-0.62; P=.0005) and the esotropia subgroup (45.2% vs 66.7%; OR=0.36, 95% CI, 0.17-0.74; P=.005). General motor-sensory success was likewise lower overall (47.2% vs 69.4%; OR=0.33, 95% CI, 0.17-0.64; P=.0007) and in esotropia (47.6% vs 70.2%; OR=0.34, 95% CI, 0.17-0.71; P=.0034). Postoperative drift was greater in the brain-injury cohort (P=.037), and failures were predominantly under-corrections. Among 60 matched esotropia pairs undergoing incisional surgery alone, surgical dosing was comparable (95.9% vs 96.6% of standard; P=.68). In the primary multiple-variable model, larger preoperative deviation was associated with lower general motor-sensory success in the combined cohort (OR=0.963 per prism diopter, 95% CI, 0.934-0.994; P=.019) and esotropia subgroup (OR=0.950, 95% CI, 0.912-0.989; P=.012). Treatment with botulinum toxin was not independently associated with success in a sensitivity model (adjusted OR=0.18; P=.126). Male sex was associated with motor failure in exotropia (OR=0.03; P=.015).
Conclusions:
Children with perinatal brain injury had lower long-term strabismus treatment success, predominantly from undercorrection, despite comparable normalized surgical dosing. Larger preoperative deviation was associated with lower success, particularly among patients with esotropia. These findings support tailored preoperative counseling regarding secondary interventions and warrant prospective studies evaluating adjusted treatment dosing in this population.