Session: Free papers Session VII - Exotropia et misc.

Outcomes of strabismus surgery in patients with Down Syndrome

Introduction 

Strabismus surgery in Down patients has been reported with variable results. Our purpose is to  describe the characteristics and outcomes of strabismus surgery in patients with Down syndrome (DS).

 

Methods

A retrospective study of patients with DS that  had strabismus surgery was performed. Type of strabismus, age at first surgery, refraction at first surgery, surgery made, results at 1 month and 2 years postoperative are reported.

 

Results

A total of 42 patients were enrolled. 31 patients had esotropia, 3 patients had exotropia, 6 patients had Superior Oblique palsy(SOP), one patient had bilateral hypertropia in adduction and one patient had congenital fibrosis of extraocular muscles. In 18 esotropia patients there was a variation similar to or greater than 50% of the maximum angle. Mean age at first surgery was 9 years old. Only 7 patients had myopia greater than 3 diopters at the time of surgery. Surgery performed in esotropia patients was bilateral medial rectus recession in 24 patients, medial rectus recession and lateral rectus resection in 4 patients and fadenoperation in 3 patients. In all 3 exotropia patients surgery performed was bilateral lateral rectus recession. In patients with SOP, surgery was superior oblique tuck plus inferior oblique weakening in two, superior oblique tuck alone in one, and inferior oblique weakening in two.

Esotropia results at 1 month and 2 years were deviation angle more than 8 dp in 7 patients ( 6 ET 1 XT )and 14 patients( 11 ET 3 XT ) respectively. New surgery was prescribed for 10 patients but it was carried out in 4.

All 3 exotropia patients had deviation less than 8 dp at 1 month and one year postoperative.

Patients with SOP had good vertical outcome but 2 of them developed esotropia.

 

Conclusions

Esotropia surgery is more frequent than exotropia.Due to variable angle of deviation, bilateral medial rectus surgery was more common. Results get worse over time. SOP and exotropia  had better outcomes than esotropia.