Restoration of fusion in children with intracranial tumors and incomitant strabismus

Purpose: Intracranial tumors may cause eye misalignment and interruption of sensory fusion, The ocular misalignment may be permanent or may be correct ed after tumor treatment with or without specific strabismus treatment. Thi s report analyzes the binocular vision outcome of children with misaligned eyes from brain tumors who regain orthotropia. Design: A retrospective noncomparative case series. Participants: Twenty-three surviving children less than 18 years of age wit h a new heterotropia and absence of fusion associated with the development of a brain tumor. Interventions: Tumor resection/radiation/chemotherapy and necessary strabis mus management. Main Outcome Measure: Stereopsis (greater than or equal to 4 of 10 circles) measured with the Randot II stereo test at near fixation. Results: Fourteen children regained orthotropia either after tumor therapy, strabismus treatment, or both. Ten of these 14 children with realigned vis ion regained high-grade stereovision, Nine patients did not regain orthotro pia and were excluded. The mean age at tumor diagnosis of the fusing group was 9.9 years (range, 3-17 years) compared with 8.5 years (range, 6-12 year s) in the four realigned nonfusing patients. The mean duration of misalignm ent was 12 months (range, 2-51 months) for the fusing group, and 45 months (range, 14-120 months) for the nonfusing group. Conclusions: Children and adolescents with brain tumor-associated eye misal ignment may regain the ability to fuse if their misalignment can be correct ed. An improved prognosis was noted for those patients when the misalignmen t had been present for a shorter duration. These data suggest that the outc ome may be better for incomitant strabismus than that reported for acute co mitant esotropia. Ophthalmology 2000;107:1880-1883 (C) 2000 by the American Academy of Ophthalmology.