Outcomes of Strabismus Procedures in Children With Perinatal Brain Injury.

PURPOSE: To compare long-term strabismus procedure success in children with perinatal intracranial injury and matched controls.

DESIGN

Retrospective cohort study.

SUBJECTS: We included 108 patients with strabismus (84 esotropia, 24 exotropia) and perinatal brain injury. Controls without brain injury were matched 1:1 by horizontal deviation type, age at intervention, and preoperative deviation magnitude.

METHODS

Patients underwent incisional surgery, botulinum toxin injection, or botulinum toxin-augmented surgery with at least 2 years of follow-up.

MAIN OUTCOME MEASURES: Two-year motor success (horizontal deviation ≤10 prism diopters) and general motor-sensory success (motor success or fine stereopsis ≤100 arcseconds), without retreatment.

RESULTS

At 3 to 6 months, success did not differ significantly (52.9% vs 67.3%; P = .098). At 2 years, motor success was lower in the brain-injury cohort overall (43.5% vs 65.7%; odds ratio [OR] = 0.31, 95% confidence interval [CI], 0.16-0.62; P = .0005) and in the esotropia subgroup (45.2% vs 66.7%; OR = 0.36, 95% CI, 0.17-0.74; P = .005). General motor-sensory success was also lower overall (47.2% vs 69.4%; OR = 0.33, 95% CI, 0.17-0.64; P = .0007) and in esotropia (47.6% vs 70.2%; OR = 0.34, 95% CI, 0.17-0.71; P = .0034). Postoperative drift was greater with brain injury (P = .037), and failures were predominantly undercorrections. Among 60 matched esotropia pairs treated surgically, dosing was comparable (95.9% vs 96.6% of standard; P = .68). In the primary multiple-variable model, larger preoperative deviation was associated with lower general motor-sensory success in the combined cohort (OR = 0.963 per prism diopter, 95% CI, 0.934-0.994; P = .019) and esotropia subgroup (OR = 0.950, 95% CI, 0.912-0.989; P = .012). Botulinum toxin treatment was not independently associated with success in a sensitivity model (adjusted OR = 0.18; P = .126). Male sex was associated with motor failure in exotropia (OR = 0.03; P = .015).

CONCLUSIONS

Children with perinatal brain injury had lower long-term treatment success, predominantly from undercorrection, despite comparable surgical dosing. Larger preoperative deviation was associated with lower success, particularly in esotropia. These findings support tailored counseling and prospective surgical dosing studies.