Strabismus and refraction in non-syndromic craniosynostosis - A longitudinal study up to 5 years of age.

PURPOSE: To evaluate the refractive outcome and strabismus at 5 years of age, in children operated for various types of non-syndromic craniosynostosis, and further analyse the refractive and strabismic development over time. METHODS: Eighty-nine children, who had undergone operations for non-syndromic craniosynostosis, were examined at 5 years of age. These children also underwent ophthalmological examination preoperatively and up to 1 year after the operation. An age-matched control group including 32 healthy children was also recruited. Strabismus and eye motility were registered. Refraction was measured in cycloplegia. RESULTS: There was a difference regarding the refractive outcome between the different types of craniosynostosis. Higher values of hypermetropia were found in the metopic craniosynostosis group on both eyes. In the unicoronal craniosynostosis group, high values of hypermetropia and a higher degree of astigmatism were found on the side contralateral to the craniosynostosis. Strabismus was found in 11/88 children of whom 10/11 had unicoronal craniosynostosis. A vertical deviation on the side ipsilateral to the fused suture was highly prevalent (6/10 cases). Ophthalmological dysfunctions were rare in children operated for sagittal craniosynostosis. CONCLUSION: Ocular manifestations such as strabismus, astigmatism and anisometropia were highly prevalent in children operated for unilateral coronal craniosynostosis. Children operated for metopic craniosynostosis had higher rates of hypermetropia. The screening and follow-up protocols need to be tailored with regard to the type of craniosynostosis.

Ophthalmological findings in children with non-syndromic craniosynostosis: preoperatively and postoperatively up to 12 months after surgery.

AIMS: Craniosynostosis is a congenital condition characterised by premature fusion of one or more cranial sutures. The aim of this study was to analyse ophthalmic function before and after cranial surgery, in children with various types of non-syndromic craniosynostosis. METHODS: Children referred to Uppsala University Hospital for surgery of non-syndromic craniosynostosis were examined preoperatively. Visual acuity was measured with Preferential Looking tests or observation of fixation and following. Strabismus and eye motility were noted. Refraction was measured in cycloplegia and funduscopy was performed. Follow-up examinations were performed 6-12 months postoperatively at the children's local hospitals. RESULTS: One hundred twenty-two children with mean age 6.2 months were examined preoperatively. Refractive values were similar between the different subtypes of craniosynostosis, except for astigmatism anisometropia which was more common in unicoronal craniosynostosis. Strabismus was found in seven children, of which four had unicoronal craniosynostosis.Postoperatively, 113 children were examined, at mean age 15.9 months. The refractive values decreased, except for astigmatism and anisometropia in unicoronal craniosynostosis. Strabismus remained in unicoronal craniosynostosis. Two new cases with strabismus developed in unicoronal craniosynostosis and one in metopic, all operated with fronto-orbital techniques. No child had disc oedema or pale discs preoperatively or postoperatively. CONCLUSION: Ophthalmic dysfunctions were not frequent in children with sagittal craniosynostosis and preoperative ophthalmological evaluation may not be imperative. Children with unicoronal craniosynostosis had the highest prevalence of strabismus and anisometropia. Fronto-orbital techniques used to address skull deformity may be related to a higher prevalence of strabismus postoperatively.

Retinal Fibre Layer Thickness Measurement in Normal Paediatric Population in Sweden Using Optical Coherence Tomography.

Purpose. To evaluate the correlation between peripapillary retinal nerve fibre layer (RNFL) thickness and both age and refraction error in healthy children using optical coherence tomography (OCT). Patients and Methods. 80 healthy children with a mean age of 9.1 years (range 3.8 to 16.7 years) undergoing routine ocular examination at the orthoptic section of the Ophthalmology Department were recruited for this cross-sectional study. After applying cycloplegia, the peripapillary RNFL thickness was measured in both eyes using the Topcon 3D OCT 2000 device. Results. 138 eyes were included in the analysis. The average refractive error (SE) was +1.7 D (range -5.25 to +7.25 D). The mean total RNFL thickness was 105 µm ± 10.3, the mean superior RNFL thickness was 112.7 µm ± 16.5, and the mean inferior RNFL thickness was 132.6 µm ± 18.3. We found no statistically significant effect of age on RNFL thickness (ANOVA, f = 0.33, p = 0.56). Refraction was proven to have a statistically significant effect (ANOVA, f = 67.1, p < 0.05) in RNFL measurements. Conclusions. Data obtained from this study may assist in establishing a normative database for a paediatric population. Refraction error should be taken into consideration due to its statistically significant correlation with RNFL thickness.