Abstract
Aim: Periventricular leukomalacia (PVL) is a type of cerebral white matter damage commonly arising within neonates born prematurely. This review aims to evaluate the literature relating to the long-term ophthalmic outcomes following PVL, focussing on the relationship between neuro-imaging and visual out- come. Methods: A literature review was undertaken between October 2013 and January 2015. Articles were sourced using PubMed, ResearchGate and forward citation searches. Results: PVL is shown to increase an individual’s chance of developing ocular defects, namely cerebral visual impairment, strabismus, visual field defects and visuoperceptual anomalies. The severity and extent of PVL is directly proportional to both the chance of developing an ocular defect, and the severity of said ocular defect; however, there is not a perfect correlation and ophthalmic outcome is specific to each individual. There have also been reports of strabismus being the presenting factor, leading to an investigation which revealed the presence of PVL that had been missed during the neonatal period. Neuro-imaging has been shown to have some predictive ability, varying depending on the area of the visual pathway examined, and the aspect of visual outcome predicted. Conclusions: While predictive results gathered via neuro-imaging can offer insight into visual outcome, these must be consolidated through non-radiological clinical testing. Strabismus has been documented as a presenting factor in patients with PVL. Therefore the initial presentation of a patient with PVL, where the diagnosis has been missed during the neonatal period, may be through the orthoptic department.
Highlights
Brain injury is a common consequence of preterm birth,[1,2] with periventricular leukomalacia (PVL), a type of cerebral white matter damage, being of importance to orthoptists owing to its location along the visual pathway.[3]
Typical key words used in literature searches initially included: periventricular leukomalacia, cerebral visual impairment, strabismus, visuoperceptual anomaly, magnetic resonance imaging and ultrasonography; additional key words were added over time
The ability of imaging modalities to predict aspects of visual outcome in patients affected by PVL has been demonstrated to vary based on the aspect of visual impairment predicted and the radiological method in question
Summary
Brain injury is a common consequence of preterm birth,[1,2] with periventricular leukomalacia (PVL), a type of cerebral white matter damage, being of importance to orthoptists owing to its location along the visual pathway.[3]. While PVL most often arises within neonates born prematurely, it may occur within babies born at full term, either spontaneously, or following septicaemia or birth asphyxia.[10,11] Irrespective of the gestational age, the consequences of PVL can be severe, affecting a range of visual functions
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