Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Departments of Anesthesiology and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
J AAPOS. 2021 Apr;25(2):76.e1-76.e5. doi: 10.1016/j.jaapos.2020.10.013. Epub 2021 Mar 11.
Prior studies comparing ophthalmic outcomes after treating unicoronal synostosis (UCS) by early endoscopic strip craniectomy (ESC) versus later fronto-orbital advancement (FOA) are modest in sample size, or lack consistent age adjustment. We report long-term, age-adjusted ophthalmic outcomes for a large cohort after nonrandomized treatment by one of these two options.
The following data was retrieved from a retrospective review of the medical records of patients with treated UCS born since 2000: cycloplegic refractions, sensorimotor examinations, and strabismus procedures before craniofacial repair and postoperatively at approximately 18 and 60 months of age. V-pattern strabismus was graded as mild (absent or + 1/-1 oblique dysfunction) versus moderate-to-severe (≥+2/-2 oblique dysfunction or left to right vertical alignment change of ≥20 or ocular torticollis >15°).
A total of 120 infants were included: 60 treated by FOA and 60 by ESC. By the late examination, aniso-astigmatism was present in 72% of FOA-treated patients and 46% of ESC-treated patients (P < 0.0001). By late examination, the age-adjusted odds ratio of moderate-to-severe V-pattern strabismus after treatment by FOA versus ESC was 2.65 (95% CI, 1.37-6.28; P = 0.02); strabismus surgery was performed in 26 infants treated by FOA compared with 13 treated by ESC (OR = 2.8; P = 0.02). Amblyopia developed in 60% of FOA-treated patients compared with 35% of those treated by ESC (OR 3.0; 95% CI, 1.3-6.7; P = 0.02).
Our age-adjusted ophthalmic results confirm better long-term outcomes after treatment of USC by endoscopic strip craniectomy. Recognition and referral of affected infants by the earliest months of life facilitates the opportunity for endoscopic repair.
先前比较单侧冠状缝早发型内镜颅缝切开术（ESC）与晚发型眶额骨前移术（FOA）治疗颅缝早闭（UCS）后眼部结果的研究，样本量较小，或者缺乏一致的年龄调整。我们报告了一项大型队列的非随机治疗后，经过长期、年龄调整的眼部结果。
从 2000 年以后出生的 UCS 治疗患者的病历回顾中检索出以下数据：在颅面修复前和大约 18 个月和 60 个月时进行睫状肌麻痹验光、感觉运动检查和斜视手术。V 型斜视分为轻度（无斜视或+1/-1 斜肌功能障碍）和中重度（≥+2/-2 斜肌功能障碍或≥20 度左右眼垂直偏斜或＞15 度眼性斜颈）。
共纳入 120 例婴儿：60 例接受 FOA 治疗，60 例接受 ESC 治疗。在晚期检查时，FOA 治疗组中有 72%的患者存在散光，而 ESC 治疗组中有 46%的患者存在散光（P<0.0001）。在晚期检查时，FOA 治疗组中中重度 V 型斜视的年龄调整比值比为 2.65（95%可信区间，1.37-6.28；P=0.02）；与接受 ESC 治疗的 13 例患者相比，接受 FOA 治疗的 26 例患者接受了斜视手术（OR=2.8；P=0.02）。FOA 治疗组中有 60%的患者出现弱视，而 ESC 治疗组中有 35%的患者出现弱视（OR 3.0；95%可信区间，1.3-6.7；P=0.02）。
我们的年龄调整后的眼科结果证实，对于 UCS 的治疗，内镜颅缝切开术的长期效果更好。通过生命最初几个月识别和转介受影响的婴儿，为接受内镜修复提供了机会。
