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Age at Craniosynostosis Surgery and Its Impact on Ophthalmologic Diagnoses: A Single-Center Retrospective Review

Bennett, Katelyn G. M.D., M.S.; Vick, Alexis D. B.S.; Ettinger, Russell E. M.D.; Archer, Steven M. M.D.; Vercler, Christian J. M.D., M.A.; Buchman, Steven R. M.D.

Plastic and Reconstructive Surgery: September 2019 - Volume 144 - Issue 3 - p 696-701
doi: 10.1097/PRS.0000000000005915
Pediatric/Craniofacial: Original Articles
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Discussion

Background: Ocular abnormalities in craniosynostosis are a persistent concern for patients and providers, and some surgeons feel that early surgical intervention for synostosis alleviates the progression of ophthalmologic abnormalities. In contradistinction, the authors hypothesize that operating early will have no bearing on postoperative ophthalmologic outcomes.

Methods: Single-suture craniosynostosis patients who underwent surgical correction between 1989 and 2015 were reviewed. Patients with multisuture craniosynostosis, syndromic diagnoses, no preoperative ophthalmology evaluation, and less than 2 years of follow-up were excluded. Logistic regression was used to determine odds of preoperative and postoperative ophthalmologic abnormalities by age, while controlling for patient-level covariates.

Results: One hundred seventy-two patients met inclusion criteria. The median age at surgery was 10 months (interquartile range, 7 to 12.9 months). Increasing age at the time of surgery was associated with increased odds of preoperative ophthalmologic diagnoses (OR, 1.06; p = 0.037) but not postoperative diagnoses (OR, 1.00; p = 0.91). Increasing age at surgery was also not associated with increased odds of ophthalmologic diagnoses, regardless of timing (OR, 1.04; p = 0.08). Patients with coronal synostosis (OR, 3.94; p = 0.036) had significantly higher odds of preoperative ophthalmologic diagnoses. Patients with metopic (OR, 5.60; p < 0.001) and coronal (OR, 7.13; p < 0.001) synostosis had significantly higher odds of postoperative ophthalmologic diagnoses.

Conclusions: After reviewing an expansive cohort, associations of both overall and postoperative ophthalmologic diagnoses with age at surgery were not found. The authors’ findings thus run counter to the theory that early surgical intervention lessens the likelihood of postoperative ophthalmologic diagnoses and improves ophthalmologic outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Ann Arbor, Mich.; and Toledo, Ohio

From the Section of Plastic Surgery, Department of Surgery, the Department of Ophthalmology, and the Section of Plastic Surgery, University of Michigan; and the University of Toledo College of Medicine and Life Sciences.

Received for publication August 20, 2018; accepted February 21, 2019.

Disclosure:Dr. Bennett was supported by the National Institute of Dental and Craniofacial Research (1F32DE027604-01) during the study period. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no other financial relationships to disclose.

Steven R. Buchman, M.D., Craniofacial Surgery Office 4730, 1540 East Medical Center Drive, Ann Arbor, Mich. 48109, sbuchman@med.umich.edu

Copyright © 2019 by the American Society of Plastic Surgeons