Brain abnormalities in infantile esotropia as predictor for consecutive exotropia
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Published on: March 24, 2020
Feyza Calis1, Huban Atilla2, Pinar Bingol Kiziltunc2
1Ophthalmology Clinic, Cihanbeyli State Hospital, Konya.
Insights
White matter damage of immaturity (WMDI) is linked to consecutive exotropia after infantile esotropia surgery. This finding suggests WMDI may be a risk factor for developing this eye alignment issue post-operation.
Area of Science:
- Ophthalmology
- Neurology
- Pediatrics
Background:
- Strabismus surgery aims to correct eye alignment, but complications like consecutive deviations can occur.
- Neurological factors, including white matter abnormalities, may impact motor and sensory fusion, affecting eye alignment control.
- White matter damage of immaturity (WMDI) is a specific brain injury affecting premature infants, potentially complicating surgical outcomes.
Purpose of the Study:
- To compare cerebral MRI findings in infantile esotropia patients who developed consecutive exotropia versus those with successful surgical outcomes.
- To investigate the association between specific MRI findings, particularly WMDI, and the occurrence of consecutive exotropia after strabismus surgery.
Main Methods:
- A comparative study involving 17 patients with consecutive exotropia (group 1) and a control group with successful surgical outcomes (group 2) after infantile esotropia surgery.
- Detailed recording and comparison of demographic, clinical, and cerebral MRI findings between the two groups.
- Analysis included age, refractive errors, angle of deviation, prematurity, and specific MRI abnormalities like WMDI, myelinization delay, and cerebellar hypoplasia.
Main Results:
- No significant differences were found in age, refractive errors, preoperative deviation angles, sex, consanguinity, prematurity, or fundus findings between the groups.
- White matter damage of immaturity (WMDI) was exclusively observed in the consecutive exotropia group (group 1).
- Other MRI findings included myelinization delay, septooptic dysplasia, and periventricular cysts in group 1, and cerebellar hypoplasia/atrophy and myelinization delay in group 2.
Conclusions:
- White matter damage of immaturity (WMDI) was present only in patients who developed consecutive exotropia after infantile esotropia surgery.
- These findings suggest that WMDI may be a significant risk factor for developing consecutive deviations in patients with infantile esotropia.
- Cerebral MRI evaluation can help identify potential risk factors for surgical complications in infantile esotropia.
Abstract:
Cerebral palsy, neurological abnormalities, prematurity or periventricular lesions may affect motor and sensory fusion mechanisms that favorably control eye alignment. White matter damage of immaturity (WMDI) is a form of white matter brain injury characterized by the necrosis of white matter near the lateral ventricles. In these cases, it is difficult to establish fusion after strabismus surgery and consecutive deviations may be seen more frequently especially in association with WMDI. The aim of this study is to evaluate and compare the cerebral magnetic resonance imaging (MRI) findings in operated infantile esotropia cases with and without consecutive exotropia and to relate them to the occurance of consecutive exotropia.Seventeen patients that had consecutive exotropia after bilateral medial rectus recession surgery for infantile esotropia were included in this study (group 1) and patients that were operated with the same diagnosis with a successful surgical outcome (≤10 PD of deviation) were recruited as group 2. Age, sex, consanguinity, associated systemic and neurological diseases, prematurity, visual acuity, angle of deviations at first visit, at last and follow-up visit and after surgery, cycloplegic retinoscopy, fundus and cerebral MRI findings were recorded. Demographic and clinical findings of patients in two groups and MRI findings were evaluated and compared.The mean age at the time of first examination was 8.21 ± 6.62 and 7.45 ± 4.94 months in infantile esotropia patients with (group 1) and without consecutive exotropia (group 2), respectively. The mean cycloplegic refractive errors (+1.92 ± 1.57 D vs. +2.30 ± 1.10 D), the mean preoperative angle of deviation (46.33 ± 18.8 PD vs. 34.8 ± 12.5 PD), sex, percentage of consanguinity, percentage of prematurity, presence of latent nystagmus, dissociated vertical deviation and amblyopia and fundus findings were similar in both groups. Patients with consecutive exotropia had a mean deviation angle of 37.5 ± 9.48 PD postoperatively. Cerebral MRI findings were consistent with WMDI (three patients), myelinization delay (one patient), septooptic dysplasia (one patient) and periventricular cysts (one patient) in group 1. Cerebellar hemispheres and vermis hypoplasia (one patient), myelinization delay (one patient), cerebellar atrophy (one patient) were the MRI findings of patients in group 2.White matter damage of immaturity was only present in the consecutive exotropia group. This finding may suggest that WMDI can be a risk factor for consecutive deviation in infantile esotropia patients.
