Relation between Preoperative Orbital Morphology and Long-Term Ophthalmologic Outcome Up to 15 Years of Age in Unicoronal Synostosis.

Abstract

Long-term ophthalmologic manifestations constitute the main functional issue in unicoronal synostosis, with large interindividual variability. The relation between preoperative orbital morphology and long-term functional outcome is not fully understood. In this retrospective cohort study, patients with nonsyndromic unicoronal synostosis treated with fronto-orbital advancement and remodeling (FOAR) between 2014 and 2023 at Necker Hospital, Paris, France, or Uppsala University Hospital, Sweden, were included and paired with controls. Preoperative computed tomography (CT) and all ophthalmologic follow-up examinations 1 year or later after surgery were included. Objective 3-dimensional measurements on CT scans were used to analyze symmetry and local and global shape differences. The degree of severity in preoperative orbital morphology was correlated to long-term outcomes of oculomotor disorders, amblyopia, anisometropia, and astigmatism. Thirty-six patients and 36 controls were included. The mean ages were 8.5 ± 7 months (range, 0.3 to 34 months) at CT examination, 12 ± 7 months (range, 8 to 36 months) at FOAR, and 6 ± 3 years (range, 2 to 15 years) at last ophthalmologic examination. Ipsilateral large global shape deformity of the orbit was related to strabismus (vertical strabismus in particular) and pseudotrochlear palsy at long-term follow-up. Neither preoperative contralateral morphology nor age at FOAR was associated with ophthalmologic outcomes. Ipsilateral oculomotor disorders at follow-up correlate with the degree of global orbital deformity primarily caused by the synostosis, suggesting that preoperative ipsilateral morphology might constitute a predictive factor for poor ophthalmologic outcome, whereas neither age at FOAR nor contralateral morphology influenced long-term ophthalmologic outcome. FOAR does not seem to prevent or reduce strabismus. Risk, II.