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Refractive error and ocular motility in plagiocephaly
D Denis1, L Genitori, A Bolufer
1Département d'Ophtalmologie, Centre Hospitalo-universitaire de la Timone, Marseille, France.
Insights
Early surgical intervention for plagiocephaly is crucial for preserving visual development. Prompt recognition of craniostenosis by ophthalmologists ensures timely reconstructive surgery, preventing long-term visual system damage.
Area of Science:
- Craniofacial surgery
- Ophthalmology
- Pediatric neurosurgery
Background:
- Plagiocephaly, caused by premature coronal suture closure, results in fronto-orbital asymmetry.
- Orbital deformation in plagiocephaly can significantly impact visual system development.
- The frontozygomatic region is identified as a key area affected by this deformation.
Purpose of the Study:
- To investigate the repercussions of orbital deformation in plagiocephaly on the visual system.
- To emphasize the importance of surgical timing for optimal visual outcomes.
- To highlight the necessity of early diagnosis and intervention for craniostenosis.
Main Methods:
- Study included 21 patients with birth-related plagiocephaly who underwent a specific craniofacial surgical technique.
- Clinical anthropometry with 3D reconstruction and complete ophthalmological examinations were performed.
- Follow-up ranged from 15 months to 4 years post-surgery.
Main Results:
- The study underscores the critical role of reconstructive surgery timing, ideally before 6 months of age.
- Severe orbital anomalies negatively affect visual development, including binocular vision, strabismus, amblyopia, and refractive errors.
- Early recognition of craniostenosis by ophthalmologists is vital for timely surgical scheduling.
Conclusions:
- Reconstructive surgery for plagiocephaly must not exceed 6 months of age due to visual system immaturity.
- Ophthalmologists play a key role in identifying craniostenosis for prompt surgical intervention.
- Collaboration between neurosurgeons and ophthalmologists is paramount to prevent visual impairment and preserve proper visual development.
Abstract:
Plagiocephaly, which is caused by premature closure of one of the coronal sutures, leads to fronto-orbital asymmetry. The aim of this work was to study the repercussions of orbital deformation on the visual system. Twenty-one patients presenting with plagiocephaly at birth and operated on by the same craniofacial technique (bilateral approach with translation and advancement of the entire involved orbits) were included in the study. All of the patients were examined by clinical anthropometry with three-dimensional reconstruction and underwent complete eye examination by the same observer. Follow-up after craniofacial surgery ranged from 15 months to 4 years. In the last few years, three-dimensional reconstruction has shown that the anatomic region affected by the deformation is the frontozygomatic region and has thus made it possible to advance to another theory on the origins of ocular problems. The severe effect of orbital anomalies on the development of the visual system (binocular vision, strabismus with amblyopia, refractive errors) has been emphasized in the literature. The present study shows that the scheduling of reconstructive surgery is fundamental and must not exceed 6 months, given the immaturity of the visual system up until this time. This means that the ophthalmologist must be able to recognize the various craniostenoses in order to schedule reconstructive surgery as soon as possible. Cooperation between the neurosurgeon and the ophthalmologist is of paramount importance if the pathogenic effects of this bone deformation are to be stopped and proper visual development preserved.