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Unicoronal synostosis is a premature fusion of one of the coronal sutures and is thought to carry an increased prevalence for strabismus. Studies suggest the nature of the strabismus to be a hypertropia occurring ipsilateral to the fused coronal suture. The aim of this study is to investigate the laterality of strabismus in unicoronal synostosis and report on ocular motility and refractive findings in a large, unbiased sample group. A retrospective case study analysis was carried out on 59 patients with a confirmed diagnosis of unicoronal synostosis referred to the Oxford Craniofacial Unit over a 14 year period. Manifest strabismus in the primary position was found in 34 (57.6%) cases. In 19 (55.9%) cases, this occurred contralateral to the fused suture, and in 9 (26.5%) cases, strabismus was on the ipsilateral side. Six had alternating strabismus. These results are contrary with apparent findings in the literature but are not statistically significant (P = 0.0872) for strabismus occurring more frequently on the nonsynostotic side. Esotropia with a vertical component was most common, found in 61% of all cases with strabismus. Apparent inferior oblique overaction was found in 30 of the 59 (50.8%) cases, with this occurring bilaterally in 14 cases. Significant refractive error was found in 46% of all cases, most of which showed anisometropia and astigmatism that occurred more frequently on the contralateral, nonsynostotic side (P = 0.0106). All cases of unicoronal synostosis with a mutation of the FGFR2 or FGFR3 gene had manifest strabismus. Manifest strabismus was found in 57.6% of cases reviewed, but this was found to be no more likely to occur on the side contralateral or ipsilateral to the fused suture (P = 0.0872). Anisometropia and astigmatism were found more frequently in the eye contralateral to the fused suture.

IntroductionHomonymous hemianopia is a common and disabling visual problem after stroke. Currently, prism glasses and visual scanning training are proposed to improve it. The aim of this trial is to determine the effectiveness of these interventions compared to standard care.Methods and analysisThe trial will be a multicentre three arm individually randomised controlled trial with independent assessment at 6 week, 12 week and 26 week post-randomisation. Recruitment will occur in hospital, outpatient and primary care settings in UK hospital trusts. A total of 105 patients with homonymous hemianopia and without ocular motility impairment, visual inattention or pre-existent visual field impairment will be randomised to one of three balanced groups. Randomisation lists will be stratified by site and hemianopia level (partial or complete) and created using simple block randomisation by an independent statistician. Allocations will be disclosed to patients by the treating clinician, maintaining blinding for outcome assessment. The primary outcome will be change in visual field assessment from baseline to 26 weeks. Secondary measures will include the Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual-5D and Short Form-12 questionnaires. Analysis will be by intention to treat.Ethics and disseminationThis study has been developed and supported by the UK Stroke Research Network Clinical Studies Group working with service users. Multicentre ethical approval was obtained through the North West 6 Research ethics committee (Reference 10/H1003/119). The trial is funded by the UK Stroke Association. Trial Registration: Current Controlled Trials ISRCTN05956042. Dissemination will consider usual scholarly options of conference presentation and journal publication in addition to patient and public dissemination with lay summaries and articles.Trial RegistrationCurrent Controlled Trials ISRCTN05956042.

Metopic synostosis is a premature fusion of the metopic cranial suture. Small case studies into the effects on vision have suggested that there is a raised incidence of astigmatic refractive error with increased risk of failure to develop normal vision if reconstructive surgery is delayed beyond 7 months of age. The aim of this study was to look at a much larger group of patients to give more statistical significance on the incidence of significant refractive error and strabismus in cases of metopic synostosis and compare this with that known for the general population of children at a similar age. A secondary objective was to look at the age at surgery and the visual outcome. A retrospective analysis of case notes was carried out for 64 children with a confirmed diagnosis of metopic synostosis attending the Oxford Craniofacial Unit. Twenty children (31%) were found to have a visual problem, with 18 needing glasses to correct a refractive error and 10 having strabismus. The nature of refractive error was generally hypermetropia, in some cases combined with low astigmatism (1.5 diopters [D] or less). Only 1 child was recorded as having more than 1.5 D of astigmatism. The age at surgery did not seem to influence visual outcome. The incidence of significant refractive error requiring correction and strabismus across the metopic group (31%) was higher than that found in the general population of children at a similar age (5%-11%). This reinforces the importance of orthoptic/ophthalmic surveillance in metopic synostosis.

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