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Age at craniosynostosis surgery and its impact on ophthalmologic diagnoses-a single-center retrospective review.

BACKGROUND
Ocular pathology in craniosynostosis is 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, we hypothesize that operating early will have no bearing on post-operative ophthalmologic outcomes.


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


RESULTS
172 patients met inclusion criteria. The median age at surgery was 10 months (IQR 7-12.9 months). Increasing age at the time of surgery was associated with increased odds of pre-operative ophthalmologic diagnoses (OR: 1.06; p=0.037) but not post-operative 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 pre-operative 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 post-operative ophthalmologic diagnoses.


CONCLUSIONS
After reviewing an expansive cohort, associations between both overall and postoperative ophthalmologic diagnoses with age at surgery were not found. Our findings thus run counter to the theory that early surgical intervention lessens the likelihood of post-operative ophthalmologic diagnoses and improves ophthalmologic outcomes.