Cortical Visual Impairment in Children − Aetiology, Clinical Findings and Neurological Findings

Abstract

Objectives: To evaluate the demographic profile, aetiology, systemic and ocular associations and findings on neuroimaging, of children with cortical visual impairment (CVI) at a tertiary eye hospital in South India. Materials and Methods: Records of 85 children with CVI, undertaking visual stimulation therapy (VST), were retrospectively analysed between March 2016 and March 2018. The data obtained was analysed for the age and gender profile, aetiology, cycloplegic refraction, fundus evaluation, MRI findings, pre and post visual stimulation therapy vision. Other associated ocular and neurological abnormalities were also noted. Results: The records of 63 boys and 22 girls were analysed. The mean age was 1.93 years with 58.8% aged <2 years were analysed. Hypoxia ischemic encephalopathy (HIE) was found to be the most common aetiology (31.7%), followed by epilepsy (27%) and structural abnormalities of brain (24.7%). Amongst the ocular associations, refractive error was the most common, seen in 42 (49.4%) children, while strabismus (exotropia>esotropia) in 40 (47%), nystagmus in 34 (40%) while pale disc in 31 (36.5%) patients. Fifty-five(64.7%) children had associated developmental delay, while 40 (47%) had seizures. Other neurological associations noted were, cerebral palsy (14.1%), microcephaly (14.1%), hearing loss in 5 and hemiparesis in 1 patient. MRI abnormalities were present in 65 (76.4%), with ischemic encephalopathy (32.9%) being the most common change noted. Conclusion: In our study cohort, HIE was found to be the most common cause of CVI, with refractive error and strabismus being the common ocular associations, while seizures and developmental delay were the common neurological associations. Neuroimaging showed that the structural insult was at both the cortical and white matter levels.