Visual Outcomes after Strabismus Surgery in Pediatric Patients with Strabismic Amblyopia: An IRIS® Registry Study.

PURPOSE

To evaluate the impact of strabismus surgery on visual outcomes in pediatric patients with strabismic amblyopia.

DESIGN

Retrospective analysis of the American Academy of Ophthalmology's IRIS® Registry (Intelligent Research in Sight).

PARTICIPANTS

Pediatric patients 3 to 17 years of age with strabismus and amblyopia.

METHODS

Visual acuity (VA) was assessed at 6, 12, and 24 months after amblyopia diagnosis. Patients were categorized based on age (3-7 years, 8-12 years, and 13-17 years) and whether they had undergone strabismus surgery before or within 6 months of amblyopia diagnosis. Propensity score matching was used to pair the patients who underwent strabismus surgery with patients who did not.

MAIN OUTCOME MEASURES

Visual acuity changes and treatment efficacy, assessed using the modified IRIS-50 outcome measure.

RESULTS

Of the 21 242 patients analyzed, 1703 patients underwent surgery within 6 months of amblyopia diagnosis and 19 539 did not. In the propensity score matching cohort, among patients with baseline VA worse than 20/30, VA significantly improved over time in both the strabismus surgery and no strabismus surgery groups. Overall, VA improved from 0.46 ± 0.21 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.29 ± 0.24 logMAR at 24 months (P < 0.001), with significant improvements observed in both groups at each follow-up (6, 12, and 24 months). Improvement was most pronounced in the youngest group (3-7 years of age), whereas teenage patients (13-17 years of age) showed no improvement. No significant differences in visual outcomes were noted between patients who had undergone strabismus surgery and those who did not at any time point. In multivariable logistic regression, no difference was found in the odds of treatment success, as measured by the IRIS-50, at the final follow-up between patients who underwent strabismus surgery and those who did not. This was true in all age categories.

CONCLUSIONS

Strabismus surgery did not impact visual outcomes significantly in patients with strabismic amblyopia. Older patients, up to at least 12 years of age, may still achieve visual benefits from both strabismus surgery and amblyopia treatment.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.