Abstract
The study aimed to evaluate the ocular motility and visual and optic disc abnormalities
in children diagnosed with periventricular leukomalacia (PVL). A retrospective analysis
was performed on 51 consecutive children who had ophthalmic symptoms and were diagnosed
with PVL by using magnetic resonance imaging. The patients were assessed for visual
function, strabismus, cycloplegic refraction, fundus examination, and if appropriate,
spectral-domain optical coherence tomography and visual field testing were applied.
The primary outcome measures were the prevalence and visual and ocular motility dysfunctions.
Mean age was 5.72 ± 2.6 years (range = 1–12), median birth weight was 2,740 g (range = 1,240–3,460),
and median gestational age was 34 weeks (range = 28–38). In total, 21 patients (39.6%)
had neurological deficit, 11 (21.5%) had intellectual disability, and 19 (37.2%) had
no neurological symptom. In the spherical equivalent refractive error and cylinder
power analysis, 10 patients had ≥3.0 D myopia, 15 had ≥3.0 D hyperopia, and eight
had ≥2.50 D astigmatism. Thirteen (25.4%) children had a best-corrected visual acuity
between 20/40 and 20/20 for Snellen card, while 9 (17.6%) had strabismic amblyopia
and 6 (11.7%) had anisometropic amblyopia. Manifest strabismus was present in 35 patients
(68.6%); of whom 12 had esotropia (23.5%), 16 had exotropia (31.3%) and 6 had vertical
deviation (11.7%). Manifest or latent nystagmus was detected in 14 patients (27.4%).
In 28 patients (54.9%), there was optic nerve abnormality. Two patients had hypoplastic
disc, 14 had optic disc pallor, 7 had large cupping, and 5 had total optic atrophy.
Six subjects underwent reliable visual field (VF) examinations, and all six had abnormal
VFs, with inferior fields being most affected. Ocular motility disorders, optic nerve
abnormalities, VF defects, and low visual acuity are common findings in this cohort
of PVL patients and maybe the only presenting signs of the disease. The recognition
of the visual disabilities and implementation of early rehabilitation may have a significant
benefit in these children.
Keywords
periventricular leukomalacia - ocular motility - visual acuity - optic nerve - visual
field
