title: Repair of strabismus and binocular fusion in children with cerebral palsy: gross motor function classification scale.
abstract: OBJECTIVE
  Children with cerebral palsy (CP) tend to be either excluded from studies of strabismus repair or pooled with children who have other neurologic disorders. The authors limited this study to children with defined CP to determine the success or failure of restoring eye alignment and fusion.
  
  
  METHODS
  An observational, cross-sectional, prospective study was conducted on a representative cohort of 50 children. CP severity ranged from Gross Motor Function Classification System (GMFCS) level 1 (least severe) to 5 (most severe). Mean age at entrance and surgery was 3.5 years, and mean follow-up was 4.1 years (minimum 1 year).
  
  
  RESULTS
  The predominant form of strabismus was infantile-onset: esotropia in 54%, exotropia in 26%, and dyskinesia in 10%. Sixty-six percent of esotropic children and 61% of exotropic children achieved optimal (microtropic) alignment after an average of 2 and 1.8 surgical procedures, respectively. The likelihood of optimal alignment was similar in children with mild (GMFCS level 1-2) versus severe (GMFCS level 3-5) CP (P = 0.7; χ(2)). Irrespective of GMFCS severity, 46% of children gained binocular fusion/stereopsis, but the quality of fusion gained was greater in children with mild CP (P < 0.05). Earlier surgery was more likely to be successful (P < 0.05).
  
  
  CONCLUSIONS
  Restoration of binocular alignment and a degree of fusion is a realistic goal in the majority of strabismic CP children. Repair may be achieved in children at both the mild and the severe ends of the GMFCS spectrum, without undue concern about treatment futility or excessive reoperation.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: Fatema
authors.initials: F
authors.lastname: Ghasia
authors.forename: Janice
authors.initials: J
authors.lastname: Brunstrom-Hernandez
authors.forename: Lawrence
authors.initials: L
authors.lastname: Tychsen
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003867:Depth Perception / Q000502:physiology*; D006801:Humans; D007223:Infant; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology*; D012086:Reoperation; D013285:Strabismus / Q000503:physiopathology / Q000601:surgery*; D014786:Vision Disorders / Q000503:physiopathology; D015348:Vision, Binocular / Q000502:physiology*