Visual outcome in 5-year-old children operated for non-syndromic craniosynostosis.

OBJECTIVE: To evaluate visual outcomes in children operated for non-syndromic craniosynostosis at preschool age, in order to elucidate long-term ophthalmological effects and guide treatment and screening strategies. METHODS: A cohort of 89 children (63 boys) with various types of non-syndromic craniosynostosis operated at Uppsala Craniofacial Centre between 2012 and 2019 and an age-matched control group of 33 healthy children underwent ophthalmological evaluations at age 5. High-contrast visual acuity (HCVA), crowding ratio, low-contrast visual acuity (LCVA), colour vision and stereo acuity were examined using standardised protocols. Statistical analyses comparing outcomes across craniosynostosis subtypes and between the study group and control group were conducted. RESULTS: Distance HCVA and LCVA were lower in children who underwent operation for unilateral coronal craniosynostosis, mainly due to the higher prevalence of strabismus and refractive error on the side contralateral to the fused suture. Amblyopia and absence of measurable stereoacuity were also more frequent in this subtype. Crowding was common in the craniosynostosis group. Near HCVA was generally lower in all craniosynostosis subtypes compared with controls. CONCLUSION: Long-term visual outcomes assessed at preschool age varied in children operated for non-syndromic craniosynostosis. Unicoronal craniosynostosis had the greatest risk of visual impairment. Tailored screening is needed in order to address the ophthalmological challenges associated with different craniosynostosis subtypes.