Ophthalmological outcomes of unilateral coronal synostosis in young children

Abstract

Background: To report refractive outcomes, describe types of strabismus and evaluate the outcomes of surgical intervention for unilateral coronal synostosis (UCS) in paediatric patients. Methods: This study retrospectively included 30 UCS cases. Patients aged from 3 months to 6 years (median: 1.8 years) were enrolled from January 2018 to December 2019 at Shanghai Children's Hospital. Sixteen patients had all types of strabismus; 15 of these patients underwent surgery. Results: Refractive errors of 30 cases were included. In 60% of patients, astigmatism of 1.00D or more existed in not less than one eye at last record. Twenty (66.7%) patients had the larger amount of astigmatism in the contralateral eye. Fifteen patients received strabismus surgery, of whom 6 patients with monocular elevation deficiency (MED) underwent the standard Knapp procedure, with or without a horizontal deviation procedure. Fifteen cases were horizontally aligned within 5 prism dioptres (Δ). Six patients with MED (100%) had attained ≥25% elevation improvement after surgery, and the vertical deviation decreased from 25.83 Δ ± 4.92 Δ (range, 20 Δ-30 Δ) to 0.83 Δ ± 4.92 Δ after surgery (range, 0 Δ-10 Δ), for an improvement of 26.67 Δ ± 4.08 Δ (t = 16 P < 0.05). In 1 patient with esotropia, the horizontal deviation decreased from + 80 Δ to + 5 Δ after surgery. One patient was diagnosed with trichiasis and one with contralateral lacrimal duct obstruction. Conclusions: Contralateral MED was also the main type of strabismus in UCS. Superior oblique muscle palsy was still the most common, as previously reported. There is a risk of developing a higher astigmatism and anisometropia in the contralateral eye to synostosis. Other ophthalmic disorders should be treated in a timely manner. Trial registration: The study was approved by the Institutional Review Board of Shanghai Children's Hospital (approval No. 2020R023-E01) and adhered to the tenets of the Declaration of Helsinki. Ethics approval was procured on March 30, 2020. This was a retrospective study. Written informed consent was sought from the patients' parents or legal guardians. Clinical Trials Registry number: ChiCTR2000034910. Registration URL: http://www.chictr.org.cn/showproj.aspx?proj=56726.

Orbital Foraminal Morphometrics in Nonsyndromic Unilateral Coronal Craniosynostosis

“…Ophthalmologic defects and visual abnormalities have been well described in association with craniosynostosis. [24][25][26][27] Astigmatism has been reported as the most common comorbid ophthalmologic conditions in patients with UCS in prior studies, [24][25][26][27] a finding that was also demonstrated in the present cohort (Table 3). In addition, the present study showed that conditions involving aberrant CNs (eg, hyperopia and trochlear nerve palsy) were more frequently involved on the synostotic side.…”

“…Ophthalmologic defects and visual abnormalities have been well described in association with craniosynostosis 24–27 . Astigmatism has been reported as the most common comorbid ophthalmologic conditions in patients with UCS in prior studies, 24–27 a finding that was also demonstrated in the present cohort (Table 3).…”

Ophthalmological Care of Patients With Craniofacial Disorders

“…Refractive errors and anisometropia are more common, certainly in unicoronal synostosis where it is postulated to be due to oblique astigmatism caused by changes in the corneal curvature as a result of the anatomical deformation in this condition. [ 13 14 15 ] It is however also more common in syndromic synostosis and does not appear to be impacted upon by craniofacial surgery. All children attending ophthalmic department should be refracted, with increased likelihood of glasses wear in those with coronal synostosis.…”

Impact of the Craniofacial Surgery Simulation in Anterior Plagiocephaly on Orbits and Oculomotor Muscles: Biomechanical Analysis With a Finite Element Model

“…Particular attention was necessary for the reconstruction of both superior oblique muscles pulleys because these are areas of interest in oculomotor disorders found in anterior plagiocephaly. 7,12 The optic nerves and the anterior segment of both eyeballs were not modelized as they were assumed to play a negligible role in strains and displacements studied. Then, the meshing was produced using Hypermesh software (Altair Engineering, Inc., Detroit, MI).…”

“…This involvement of the both trochlear areas in regards of the pulleys of the superior oblique muscles, is interesting because V-pattern strabismus with hypofunction of the superior oblique muscle is often described in patient with anterior plagiocephaly. 12,16,17 The presence of strain on the insertion of the pulley of the superior oblique muscle may be a contributing factor for the V-pattern strabismus. It would be necessary to evaluate the evolution of this area of strain during the postoperative period.…”