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Published on: October 14, 2022
Esotropia in Children with Ventricular-Peritoneal Shunts
Caroline N DeBenedictis1, Steven E Rubin1, Sylvia R Kodsi1
1a Department of Ophthalmology , North Shore - Long Island Jewish Health System , Great Neck , NY , USA.
Insights
Children with hydrocephalus and ventricular-peritoneal shunts often have congenital esotropia. Despite developmental delays, successful ocular alignment is achievable through strabismus surgery or glasses.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Neurosurgery
Background:
- Strabismus is more prevalent in individuals with hydrocephalus compared to the general population.
- Esotropia, a form of strabismus, is a common concern in pediatric patients with hydrocephalus requiring shunt placement.
Purpose of the Study:
- To investigate the characteristics and treatment outcomes of pediatric patients diagnosed with esotropia who have undergone ventricular-peritoneal shunt placement for hydrocephalus.
Main Methods:
- A retrospective chart review was conducted on pediatric patients with esotropia and a history of ventricular-peritoneal shunt placement.
- Data were collected from January 2000 to December 2010.
Main Results:
- Sixteen pediatric patients (age 3 months to 5.6 years) were included. Nine were premature, and most had developmental delay.
- Hydrocephalus, often diagnosed before esotropia, was linked to intraventricular hemorrhage or congenital causes in 75% of cases.
- Successful ocular alignment (<10 prism diopters) was achieved in 56% of patients; 78% of those undergoing strabismus surgery had successful alignment.
Conclusions:
- Children with ventricular-peritoneal shunts may have a higher incidence of congenital esotropia compared to acquired forms.
- Despite frequent developmental delays, effective ocular alignment is attainable in this patient group.
Purpose:
Compared with the general population, patients with hydrocephalus are more likely to have strabismus. This study was undertaken to examine characteristics and outcomes of children with esotropia and ventricular-peritoneal shunt placement due to hydrocephalus.
Methods:
This is a retrospective chart review of all pediatric patients with esotropia and a history of ventricular-peritoneal shunt placement seen by our pediatric ophthalmology service between January 2000 and December 2010.
Results:
Sixteen patients between the age of 3 months and 5.6 years met study criteria. Nine were premature and all but one of the patients had developmental delay. Although all patients had a ventricular-peritoneal shunt, the diagnosis leading to shunt placement was intraventricular hemorrhage or congenital hydrocephalus in 75% of the patients. In all but 3 patients the hydrocephalus was diagnosed before the esotropia. Ten children had congenital esotropia and 6 had acquired esotropia. Eleven of the 16 children required glasses: 5 had a myopic prescription and 6 had a hyperopic prescription. Treatment of the esotropia resulted in 9 patients (56%) with successful ocular alignment (<10 prism diopters) on their last visit: 7 underwent strabismus surgery and 2 were treated with glasses only. Of the 9 patients who had strabismus surgery, 6 had congenital esotropia and 3 had acquired esotropia. Among patients who underwent strabismus surgery, 78% had successful ocular alignment at their last visit.
Conclusions:
While acquired accommodative esotropia is more common in the general population, children with ventricular-peritoneal shunts may be more likely to have congenital esotropia. Although developmental delay is very frequent, successful ocular alignment may be possible in this patient population.
