Purpose
To investigate the correlation between clinical features of strabismus and motor dysfunction
classified according to the Gross Motor Function Classification System (GMFCS) in patients with spastic cerebral palsy (CP).
Methods
In this retrospective, cross-sectional study in single tertiary medical center, 62 patients who
are diagnosed with spastic CP who had an ophthalmic examination between 2006 and 2014 were included. Only patients with vision sufficient to fixate were included and patients with restrictive or paralytic strabismus were excluded. The types of CP were classified as diplegia, hemiplegia, or quadriplegia for distribution of motor impairment. The GMFCS was used to grade gross motor dysfunction, which was then classified as mild (grade 1, 2 and 3) or severe (grade 4 and 5) motor impairment(Table 1). Strabismus was investigated in terms of direction, constancy, and deviation angle. The relationship between strabismus characteristics and the level of GMFCS and type of CP were assessed.
Results
Thirty-eight and 24 patients had mild or severe motor deficit, respectively(Table 2). Forty patients had strabismus, which was more frequent in patients with severe motor impairment (P = .014). Exotropia and esotropia occurred with similar frequency. Constant and large-angle strabismus was frequently observed in patients with severe motor impairment.(P < .005, 0.027)(Fig. 1). The topographical subtype of CP was not related to clinical features of strabismus(Fig. 2). There was no correlation between the refractive errors and the GMFCS severity(Table 3). Visual acuity was measured in 32(51.6%) patients(Table 4). GMFCS grade was only the risk factor for strabismus on univariate(P= .001) and multivariate(P= .001) analysis(Table 5).
Conclusions
The prevalence of strabismus is higher in severe motor impairment. The constancy and
angle of strabismus was related to the severity of motor impairment while the topographical subtype of CP has no significant relationship. |
