title: Improving ophthalmic outcomes in children with unilateral coronal synostosis by treatment with endoscopic strip craniectomy and helmet therapy rather than fronto-orbital advancement.
abstract: OBJECTIVE
  To compare long-term ophthalmic outcomes in infants treated for unilateral coronal synostosis (UCS) by endoscopic strip craniectomy (ESC) and helmet therapy with those treated by fronto-orbital advancement (FOA).
  
  
  METHODS
  Consecutive patients with UCS, uncomplicated by other suture synostosis, were identified by a retrospective review of medical records. Assessment of presence of amblyopia, cycloplegic refraction, strabismus, and strabismus surgical intervention at all visits was recorded.
  
  
  RESULTS
  Between 2004 and 2010, 22 patients were treated by FOA (mean follow-up, 21.5 months) and 21 patients with ESC and helmet therapy (mean follow-up, 23.5 months). The mean aniso-astigmatism was equal; however, the SD was greater for those treated by FOA (P < 0.05). A more severe pattern of strabismus developed in those treated by FOA (P < 0.0001). Those treated by FOA were more likely to have amblyopia (P = 0.0015) and to undergo surgical correction of their strabismus (odds ratio, 6.3:1).
  
  
  CONCLUSIONS
  Children with UCS treated with ESC and helmeting had less severe overelevation in adduction, amblyopia, extremes of astigmatism, and less need for strabismus surgery than those treated by FOA. Although the reason for these more favorable outcomes remains uncertain, we speculate that the earlier timing of ESC or differences in the anatomical changes resulting from the two procedures may play a role.
authors.affiliation: Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: MacKinnon
authors.forename: Mark R
authors.initials: MR
authors.lastname: Proctor
authors.forename: Gary F
authors.initials: GF
authors.lastname: Rogers
authors.forename: John G
authors.initials: JG
authors.lastname: Meara
authors.forename: Sarah
authors.initials: S
authors.lastname: Whitecross
authors.forename: Linda R
authors.initials: LR
authors.lastname: Dagi
mesh_terms: D000550:Amblyopia / Q000209:etiology; D003393:Cranial Sutures / Q000000981:diagnostic imaging / Q000601:surgery*; D003398:Craniosynostoses / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D004724:Endoscopy; D005133:Eye Movements / Q000502:physiology; D005500:Follow-Up Studies; D006260:Head Protective Devices; D006801:Humans; D007223:Infant; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D012189:Retrospective Studies; D013285:Strabismus / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology