Strabismus Repair in Children with Varying Severity of Cerebral Palsy

Objective: To study the success rate of strabismus surgery in patients with varying levels of severity of cerebral palsy (CP).

Design: A retrospective study was conducted.

Participants: Sixty-four patients with varying severity of CP were included.

Methods: All patients with different CP severity levels underwent strabismus surgery. Success was defined as any postoperative heterotropia outcome of less than 10 prism diopters in primary position. Statistical analysis was conducted using chi-square.

Results: The mean age at the time of strabismus surgery was 3.1 years, and the mean follow-up was 6.0 years. The most common types of strabismus were infantile-onset exotropia in 36 patients (56%) and infantile-onset esotropia in 28 patients (44%). Surgical success was found to be better in patients with mild GMFCS (GMFCS levels 1-2) with 68% having less than 10 PD of eso or exotropia in primary gaze, as compared to patients with severe GMFCS (GMFCS levels 3-5) (38% with 10 PD of heterotropia) (P < .05; χ2). Refractive errors included myopia (27.5% in mild cases and 41.6% in severe), emmetropia (10% in mild and 8.3% in severe) and hyperopia (62.5% in mild and 50% in severe). Around 50% of the mild cases had absent binocular fusion compared to 66.6% of those with severe CP. Amblyopia was found in 62.5% of the mild cases and 54.1% of the severe cases. Nystagmus was present in 25% with mild disease and 29.1% of those with severe disease.

Conclusion: Restoration of good ocular alignment in patients with CP is achievable in more than half of the cases. Patients with more severe CP have poorer outcomes than those with milder palsies. There appears to be no difference in outcomes between the different types of strabismus.