Comparing Pre- and Post-operative Refraction Following Cranial Vault Remodeling for Craniosynostosis

OBJECTIVE: Craniosynostosis can lead to anatomic deformation of the cranial vault, skull base, and orbits. Select phenotypes of craniosynostosis are associated with ophthalmologic comorbidities including strabismus, refractive changes, and anisometropia. The objective of this study is to determine the incidence of ophthalmologic comorbidities and compare the severity of refractory errors before and after cranial vault remodeling (CVR) for craniosynostosis. METHODS: Retrospective review of patients who underwent surgical correction for craniosynostosis with perioperative ophthalmology exams was conducted. Data points gathered included gender, race/ethnicity, craniosynostosis phenotype, surgical approach, surgical repair technique, syndromic, second craniosynostosis surgery required, strabismus type, refractory errors, development of amblyopia, and development of anisometropia. Cycloplegic refraction data was collected and subdivided into pre-operative, early post-operative (1 month to 6 months), and post-operative (1 year to 3 years) periods. A between subjects repeated measure ANOVA and paired T-tests were conducted to assess postoperative changes in refraction. RESULTS: Our cohort included 168 patients and was 68% male and 80% white. The average age at repair was 11 months and 11% had a diagnosis of syndromic craniosynostosis. The most common craniosynostosis phenotype was sagittal (46%), followed by metopic (23%), unicoronal (11%), multisuture (9%), bicoronal (7%), and lambdoid (3%). Of all patients, 27% had strabismus, 60% of strabismus was a form of exotropia/exophoria, and 95% of the cohort had refractory errors— 40% had hyperopia alone and 41% had hyperopic astigmatism. Overall, 14% of the cohort developed amblyopia and 4% developed anisometropia. Results of the ANOVA showed no statistically significant difference in refraction changes among any variables pre-operative to post-operative. Paired t-tests showed that when all children were combined, refraction decreased by -0.44 (p<0.01) from the pre-operative to 1-year post-operative period and by -0.83 (p<0.01) from the pre-operative to 3-year post-operative period. There was no difference in refraction from the early post-operative period to the 1-, 2-, or 3-year post-operative period. CONCLUSION: Post-operative changes in refraction occur in children with craniosynostosis up to at least 3 years post-operatively. This study supports that there are no patient-specific variables available for predicting postoperative refractory changes in this patient population. The collected data re-emphasizes the need for long-term ophthalmology follow-up and integration of ophthalmology onto multidisciplinary craniosynostosis care teams. CORRESPONDING AUTHOR: Hanna Pfershy, 53 Batavia Pl NE Grand Rapids, MI 49503, [email protected] 248-763-0718