Perinatal visual loss

Abstract

Brodsky et al1Brodsky M.C. Fray K.J. Glasier C.M. Perinatal cortical and subcortical visual loss mechanisms of injury and associated ophthalmologic signs.Ophthalmology. 2002; 109: 85-94Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar reported the associated ocular findings in 100 children with perinatal cortical and subcortical visual loss. Optic nerve hypoplasia without atrophy was present in 8% (4/50) of patients with cortical visual loss and 26% (13/50) of patients with subcortical visual loss. Optic nerve hypoplasia with atrophy was seen in 12% (6/50) of patients with cortical visual loss and 24% (12/50) with subcortical visual loss. Optic atrophy was noted in 24% (12/50) of patients with cortical loss and 26% (13/50) with subcortical visual loss. As the author’s note, (and as opposed to adults with cortical visual loss), preterm injury to the retrogeniculate visual pathway can result in transsynaptic degeneration of optic nerve axons and secondary optic atrophy with or without optic nerve hypoplasia.1Brodsky M.C. Fray K.J. Glasier C.M. Perinatal cortical and subcortical visual loss mechanisms of injury and associated ophthalmologic signs.Ophthalmology. 2002; 109: 85-94Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar Jacobson et al2Jacobson L. Hellström A. Flodmark O. Large cups in normal-sized optic discs a variant of optic nerve hypoplasia in children with periventricular leukomalacia.Arch Ophthalmol. 1997; 115: 1263-1269Crossref PubMed Scopus (97) Google Scholar reported an interesting additional finding of large optic cups with normal-sized optic discs and the authors suggested that this might be due to transsynaptic degeneration that occurs after the normal scleral canal has formed. I was wondering if Brodsky et al found glaucomatous-like cupping in addition to optic atrophy, with or without optic nerve hypoplasia, in any of the patients in their series. In speaking with our glaucoma experts there seems to be general agreement that this type of cupping can be seen (albeit rarely) in children who have suffered a perinatal hypoxic-ischemic event. The importance of the finding of an enlarged cup in this setting is that a child with visual loss and cupping might undergo inappropriate treatment for congenital glaucoma when the true etiology is cortical or subcortical visual loss. ErratumOphthalmologyVol. 110Issue 6Preview Full-Text PDF Author replyOphthalmologyVol. 110Issue 6Preview Full-Text PDF Author replyOphthalmologyVol. 110Issue 4Preview Full-Text PDF