Strabismus surgery outcomes in pediatric patients with developmental delay: a meta analysis

Theme: Paediatric ophthalmology and strabismus
What: Paediatric ophthalmology and strabismus
Part of: Paediatrics II: Strabismus- Innovations and Challenging Cases / Pédiatrie II: Ophtalmologie pédiatrique et strabisme - Dépistage du rétinoblastome
When: 6/2/2024, 11:15 AM - 12:45 PM
Where: Room | Salle 714 A

Abstract

 

Purpose: The prevalence of strabismus is markedly increased in children with developmental delays, such as cerebral palsy, hydrocephalus, down syndrome, chromosomal anomalies, and many other syndromic children. In children with developmental delays, the prevalence of strabismus is approximately 44%, in contrast to the significantly lower prevalence of about 2% in the general population. Intervention of strabismus in these children is a contentious issue due to the unpredictable outcomes influenced by factors such as cortical visual impairment, limited neuroplasticity, and poor patient cooperation. Surgeons are often faced with parental pressures to align the eyes surgically. This meta-analysis aims to understand the strabismus surgical outcomes in children with developmental delay.

Study Design: Meta-Analysis

Methods: Eligible studies published before May 28th, 2023, were extracted from MEDLINE, EMBASE, CINAHL, Cochrane, and PsychINFO, as well as grey literature. Using Covidence, duplicate records were removed, and two independent reviewers assessed each record for relevance. Afterwards, a risk of bias assessment was conducted. Data were extracted and a meta-analysis was performed using STATA 14.0. Fixed-effect and random-effect models were computed based on heterogeneity.

Results: Our meta-analysis of 31 articles involved 3,687 subjects. We found that 37% of children with developmental delays undergo strabismus surgery. There was no significant difference in surgical dose (SMD -0.06, 95% CI: [-0.36,0.23]) between developmentally delayed and normal children. Though children with developmental delays had larger preoperative angles of deviation (SMD 0.34, 95% CI: [0.07,0.61]), post-operative angles of deviation were similar between the two groups (SMD -0.20, 95% CI: [-0.51,0.11]). In developmentally delayed children, the angle of deviation significantly improved (SMD 2.79, 95% CI: [2.50,3.08]) after surgery. The success rate of achieving orthotropia was lower in developmentally delayed (59.5%) compared to normal children (75.79%). The success rate of achieving binocular vision in developmentally delayed children was 17.5% compared to 42% seen in normal children. Among developmentally delayed children undergoing surgery, 71.45% had one operation, 23.9% had two, and 7.15% had three. Undercorrection rates were similar between the groups (20.4% vs 20.2%), but overcorrection rates were higher in children with delays (12%) compared to normal ones (4.35%).

Conclusion: Strabismus surgery in developmentally delayed children is a viable treatment option to improve misalignment of the eyes, however, it is associated with higher rates of re-operation, overcorrection, and worse rates of achieving binocular vision compared to normal children. These findings will help in objective discussions with the family to allow them to make educated decisions on whether to operate.

Presenter(s)

Presenting Author: Edward Tran

Additional Author(s):

Vivian Phu, Western University

Monali Malvankar, Ivey Eye Institute

Sapna Sharan, Ivey Eye Institute

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