Early posterior cranial vault distraction in syndromic craniosynostosis: orbital and ocular changes.

Craniosynostosis is a condition involving premature fusion of the skull, which causes increased intracranial pressure. Posterior cranial vault expansion distraction osteogenesis (PCVDO) may be applied to expand the intracranial volume and relieve the increased intracranial pressure, but its impact on intraorbital volume and ophthalmology outcomes remains unclear. This study was performed to evaluate the changes in intracranial and intraorbital volumes and key ophthalmological parameters (degree of proptosis, intraocular pressure, lagophthalmos, papilledema, optic disc hyperaemia, optic atrophy, retinal vascular tortuosity, and strabismus) in six children with syndromic craniosynostosis treated with PCVDO. The volumetric and ophthalmological parameters were assessed using computed tomography scans and patient records. Following PCVDO, all patients showed increased intracranial and intraorbital volumes. There was a significant improvement in intraocular pressure (right eye P = 0.004, left eye P = 0.005), papilledema (P = 0.039), and optic disc hyperaemia (P = 0.037). However, the results showed no significant improvement in optic atrophy, strabismus, retinal vascular tortuosity, ocular proptosis, or lagophthalmos from pre- to post-PCVDO. The study findings suggest that PCVDO effectively reduces intraocular pressure, papilledema, and optic disc hyperaemia, with potential implications for ocular health and ocular proptosis.