Gencarelli John R, Murphy Amanda, Samargandi Osama A, Bezuhly Michael
Division of Plastic & Reconstructive Surgery, Dalhousie University, Halifax, Canada.
J Craniofac Surg. 2016 Oct;27(7):1629-1635. doi: 10.1097/SCS.0000000000003085.
Unicoronal craniosynostosis predisposes to ophthalmologic abnormalities such as strabismus, astigmatism, and amblyopia. The authors explored the ophthalmologic outcomes following fronto-orbital advancement (FOA). A systematic search of PubMed, Embase, and the Cochrane Library was conducted. Included studies reported postoperative rates of strabismus, astigmatism, and/or amblyopia. Two independent reviewers performed screening and extracted data including preoperative rates, laterality and severity of findings, need for ocular surgery, and timing of FOA. Methodologic quality was assessed using the Methodologic Index for Non-Randomized Studies scale and American Society of Plastic Surgeons Evidence Rating Scale for Therapeutic Studies. A total of 231 abstracts were screened. Sixteen articles were eligible for qualitative synthesis including 13 case series and 3 retrospective comparative studies. Nine studies contained both preoperative and postoperative data, but for strabismus only. Postoperative prevalence of strabismus was 19% to 100%. Rates increased in 4 studies and decreased in 3. Incidences of new and resolved cases of strabismus were 0% to 60% and 0% to 33%, respectively. Twenty-five percent to 100% of patients required strabismus surgery. Postoperative rates of astigmatism were 15% to 92%. Fourteen percent to 41% had clinically significant anisometropia, predisposing to amblyopia. The postoperative prevalence of amblyopia was 3% to 56%. In summary, FOA does not appear to reduce rates of strabismus, astigmatism, or amblyopia. In addition, surgery carries the risk of iatrogenic strabismus. Earlier intervention and endoscopic techniques may reduce prevalence and severity, but additional research is required.
单侧冠状缝早闭易导致斜视、散光和弱视等眼科异常。作者探讨了额眶前移术（FOA）后的眼科结局。对PubMed、Embase和Cochrane图书馆进行了系统检索。纳入的研究报告了斜视、散光和/或弱视的术后发生率。两名独立评审员进行筛选并提取数据，包括术前发生率、发现的偏侧性和严重程度、眼科手术需求以及FOA的时机。使用非随机研究方法学指数量表和美国整形外科医师协会治疗研究证据评级量表评估方法学质量。共筛选了231篇摘要。16篇文章符合定性综合分析的条件，包括13个病例系列和3项回顾性对照研究。9项研究包含术前和术后数据，但仅针对斜视。斜视的术后患病率为19%至100%。4项研究中发生率增加，3项研究中发生率降低。斜视新发病例和缓解病例的发生率分别为0%至60%和0%至33%。25%至100%的患者需要进行斜视手术。散光的术后发生率为15%至92%。14%至41%的患者有临床上显著的屈光参差，易导致弱视。弱视的术后患病率为3%至56%。总之，FOA似乎并未降低斜视、散光或弱视的发生率。此外，手术存在医源性斜视的风险。早期干预和内镜技术可能会降低患病率和严重程度，但还需要更多的研究。
