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Visual function in infants with congenital hydrocephalus with and without myelomeningocoele
1Neurosurgery Division, Department of Surgery, Lagos State University College of Medicine and Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria, oeidowu412@yahoo.com.
Insights
Congenital hydrocephalus can cause visual issues. Optic atrophy is rare in hydrocephalus with myelomeningocoele, and the Evans ratio predicts optic nerve damage in infants.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Medical Imaging
Background:
- Congenital hydrocephalus (HC) can lead to visual impairments.
- Understanding optic nerve deficits and refractive errors is crucial for affected children.
Purpose of the Study:
- To determine the frequency of optic nerve deficits and refractive errors in infants with congenital hydrocephalus.
- To investigate the relationship between these visual impairments and neuroradiological measurements, specifically the Evans ratio.
Main Methods:
- Prospective study of infants with congenital hydrocephalus with (MHC) and without (HC) myelomeningocoele.
- Clinical neuro-ophthalmological evaluations and neuroimaging (Evans ratio, third ventricular diameter).
Main Results:
- 36% of patients had impaired visual tracking; 18% had optic atrophy, significantly more common in the HC group (p=0.007).
- MHC group showed significantly lower Evans ratios (frontal and occipital, p=0.000).
- 49 patients had anisometropia, with hypermetropia being the most common refractive error (46 patients), not significantly associated with HC or MHC.
Conclusions:
- Optic atrophy is less common in MHC, likely due to earlier presentation and lower Evans ratios.
- The Evans ratio is a valuable predictive index for optic atrophy in infantile congenital hydrocephalus.
- Refractive error prevalence is independent of myelomeningocoele association in hydrocephalus.
Objectives:
Congenital hydrocephalus without or with associated myelomeningocoele has impaired visual function as a potential complication. The present study was embarked on to determine the frequency of optic nerve deficits and refractive errors in this group of children and document any relationship to neuroradiological measurements.
Materials And Methods:
All infants with congenital hydrocephalus associated with myelomeningocoele (MHC) and congenital hydrocephalus without myelomeningocoele (HC) were prospectively studied. The children underwent clinical neuro-ophthalmological evaluation and neuroimaging. Radiological confirmation and severity of hydrocephalus was by Evans ratio (frontal and occipital) and third ventricular diameter.
Results:
There were 50 children (27 boys and 23 girls, median and mean age of 6 and 5.4 months, respectively) included in the study. Eighteen patients (36%) had no or poor visual tracking and fixation, while nine (18%) patients had optic atrophy. Optic atrophy was significantly associated with the HC group (p = 0.007), while the MHC group was significantly associated with a lower Evans ratio (occipital ratio, p = 0.000; frontal ratio, p = 0.000). Forty-nine patients had anisometropia. The refractive errors were more commonly hypermetropia (46 patients). This was not significantly associated with HC or MHC (0.309).
Conclusion:
Optic atrophy rarity in MHC is probably due to early presentation of the patients and lower Evans ratio (occipital and frontal). Evans ratio is a good predictive index for optic atrophy in infantile congenital hydrocephalus. Refractive errors frequency is not dependent on an association of myelomeningocoele with or without hydrocephalus.
