Ophthalmic Manifestations in Children with Periventricular Leukomalacia
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To the Editor: Periventricular leukomalacia (PVL), an important neuroradiological sign of perinatal cerebral damage, causes visual impairment in children . We retrospectively analysed the predisposing factors and ophthalmic manifestations in children <16 y with MRI evidence of PVL in a tertiary care centre of Northern India.
Records of 32 patients with PVL were analysed. Mean presenting age was 51.2 mo. Antenatal and perinatal history was positive in 43.7% and 96.8% children respectively (preterm in 65.6%, delayed cry in 54.2%, NICU admission in 81.2%, oxygen therapy in 50%, perinatal seizures in 34.3%, feeding difficulties in 21.8% and pathological jaundice in 34.3%). Hypoglycemia, sepsis and birth asphyxia were cumulatively present in 20.6%. The major risk factor was perinatal hypoxia.
The commonest presenting ocular complaint was strabismus (59.3%) , followed by poor eye contact, poor visual response, poor hand eye coordination, keeping eyes in upgaze and decreased vision. PVL may go undiagnosed in absence of strabismus . Visual level was assessed as classified and described by Huo . Vision was better than grade 3 in 62.5% children. Contrary to previous studies , the number of children fixing and following light (level 3) in our study were comparable to those with vision upto 20/50 (level 4, 5).
Simple hyperopic astigmatism was the commonest refractive error. Myopia ranged upto −9.25DS whereas hyperopia ranged upto 4.5DS. Exotropia was seen in 12(37.5%) patients whereas 10(31.2%) children had esotropia . Nystagmus was present in 13(40.6%) patients, most common being horizontal jerk nystagmus in 7 children, followed by latent nystagmus in 3 children, rotatory nystagmus in 2 children and end-gaze nystagmus in 1 child. On posterior segment evaluation, temporal disc pallor was seen in 10 patients whereas diffuse pallor was present in 5 patients. Vision and disc appearance were in concordance with each other in 10 out of 32 children. Pursuits and saccades could be recorded in 17(53.1%) patients; they were normal in 4 patients (23.5%) only.
Inspite of severe ophthalmic manifestations seen in PVL, only 2 children were referred to ophthalmologists for early interventions. To conclude, increased emphasis on early visual function interventions can aid in better therapeutic recovery of children with PVL.
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