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The Indian Journal of Pediatrics

, Volume 85, Issue 7, pp 572–572 | Cite as

Ophthalmic Manifestations in Children with Periventricular Leukomalacia

  • Suma Ganesh
  • Rolli Khurana
  • Batriti Wallang
  • Sonia Sharma
Scientific Letter
  • 360 Downloads

To the Editor: Periventricular leukomalacia (PVL), an important neuroradiological sign of perinatal cerebral damage, causes visual impairment in children [1]. 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%) [2], 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 [3]. Visual level was assessed as classified and described by Huo [4]. Vision was better than grade 3 in 62.5% children. Contrary to previous studies [4], 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 [5]. 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.

Notes

Compliance with Ethical Standards

Conflict of Interest

None.

References

  1. 1.
    Jacobson LK, Button GN. Periventricular leukomalacia: an important cause of visual and ocular motility dysfunction in children. Surv Ophthalmol. 2000;45:1–13.CrossRefPubMedGoogle Scholar
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    Chhablani PP, Kekunnaya R. Neuro-ophthalmic manifestations of prematurity. Indian J Ophthalmol. 2014;62:992–5.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Muen WJ, Saeed MU, Kaleem M, Abernethy L, Chandna A. Unsuspected periventricular leukomalacia in children with strabismus: a case series. Acta Ophthalmol Scand. 2007;85:677–80.CrossRefPubMedGoogle Scholar
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    Huo R, Burden SK, Hoyt CS, Good WV. Chronic cortical visual impairment in children: aetiology, prognosis, and associated neurological deficits. Br J Ophthalmol. 1999;83:670–5.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Brodsky MC. Pediatric neuro-ophthalmology. 3rd ed. New York: Springer; 2016.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2018

Authors and Affiliations

  • Suma Ganesh
    • 1
  • Rolli Khurana
    • 1
  • Batriti Wallang
    • 1
  • Sonia Sharma
    • 1
  1. 1.Pediatric Ophthalmology and Strabismology ServicesDr. Shroff’s Charity Eye HospitalNew DelhiIndia

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