Pediatric cortical visual impairment: Etiology, associated findings, and prognosis in a tertiary eye care setting in South India

• Main Authors: Neelam Pawar, Meenakshi Ravindran, Renagappa Ramakrishnan, Devendra Maheshwari
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2018-01-01
• Series: Journal of Clinical Ophthalmology and Research
• Subjects: Hypoxic ischemic insult; neuroimaging; pediatric cortical visual impairment; periventricular leukomalacia
• Online Access: http://www.jcor.in/article.asp?issn=2320-3897;year=2018;volume=6;issue=2;spage=53;epage=58;aulast=Pawar

Purpose: The purpose of this study is to evaluate the etiology, prognosis, and associated neurological and ophthalmologic findings of pediatric cortical visual impairment (CVI) at a tertiary care center in South India. Methods: Records of 120 patients visiting either directly or referred by pediatrician and pediatric neurologist during 2006–2012 at a tertiary eye care hospital were retrospectively reviewed. Ninety children were diagnosed with CVI. The diagnosis of CVI was based on an ocular examination that revealed poor visual function bilaterally that could not be accounted by age, ocular examination findings, optic atrophy, or high refractive error and neuroimaging results were correlated. The modification of the six-level scale was used (graded on a scale of I to VI) for visual acuity. Results: The mean age at presentation was 19 ± 17.21 months (range 2–96 months). The mean age at follow-up was 29.05 ± 25.61 months (range 8–108 months). In this study, 79% of the patients at initial presentation had Level I or level II vision acuity. The most common etiology was perinatal hypoxia (29%), followed by prematurity (26%), and structural abnormalities (22%). Forty-one children (46%) had some neurological manifestation, and 34% had ocular deficits. The most common findings were ischemic encephalopathy (31%), periventricular leukomalacia (28%), cortical and subcortical atrophy and structural malformations (22%). Conclusion: The major risk factors for pediatric CVI are perinatal hypoxia, premature birth, and structural abnormalities. Most patients have associated neurological and ophthalmologic abnormalities. The majority of children with CVI showed some recovery, but visual function tended to be poor in most children.