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Optic nerve injury in children. A prospective study of 35 patients
1All India Institute of Medical Sciences, New Delhi.
Insights
Visual Evoked Potentials (VEP) aid in assessing optic nerve injury in children. Absent VEPs in pediatric patients with optic nerve trauma correlated with visual recovery, highlighting VEP
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Trauma Surgery
Background:
- Optic nerve injury in children presents unique diagnostic and management challenges.
- Traumatic optic neuropathy requires prompt and accurate assessment for optimal outcomes.
Observation:
- This prospective study analyzed 35 children under 15 with optic nerve injury.
- Common causes included falls, with skull fractures noted in one-third of cases.
- Visual Evoked Potentials (VEP) were recorded in 30 children.
Findings:
- Absent VEPs in 17 children with optic nerve injury did not preclude visual recovery.
- Children with absent VEPs showed a 77% rate of visual recovery.
- Spontaneous visual recovery occurred in 12 patients overall.
Implications:
- VEP is a valuable tool for evaluating optic nerve injury in pediatric patients.
- The findings suggest that absent VEPs should be interpreted cautiously regarding prognosis.
- Non-routine optic canal decompression was employed, with VEP guiding management decisions.
Abstract:
Thirty-five children under 15 years of age with optic nerve injury are prospectively studies for their clinical presentation, radiological findings, visual evoked potentials and outcome. Over 50% were under 10 years of age. In half of the children, injury was due to fall from a height. Fracture of the skull was recorded in a third of the patients, and optic canal fracture was seen only in three children. Visual Evoked Potentials (VEP) were record in 30 children and were repeated several times in first three weeks. All the patients received corticosteroids and optic canal decompression was not carried out routinely. Overall spontaneous visual recovery was observed in 12 patients. Among the 30 children in whom Veps were recorded, 17 children had repeatedly absent VEP, and none of the children showed wave formation, 10 (77%) had visual recovery. Only in 5 patients an optic canal decompression was carried out several weeks after injury. This study brings out the role of VEP in children with optic nerve injury.