No abstract

SUMMARY Thirteen preterm children, aged 4 to 14 years, with visual impairment due to periventricular leukomalacia (PVL) were evaluated for visual function, intellectual level, cognitive profile and motor function. Their visual impairment was characterized by low acuity, crowding, visual field defects and ocular motility disturbances. Their cognitive profile was uneven, often with considerably higher scores on verbal than on visual‐spatial tasks. Nine children had normal intelligence, three had mild mental retardation and one had severe mental retardation. In all the children, visual impairment was complicated by visual perceptual difficulties, accounting for their greater visual handicap than would be expected from their visual acuities and strabismus alone. Though CT or MRI revealed bilateral PVL in all the children, six had no motor impairment consistent with cerebral palsy, which is an unexpected finding. RÉSUMÉ Troubles visuels chez le prématuré avec leacomalacie péri‐ventriculaire‐caractéristiques visuelles, cognitives el neuropédiatriques reliees àľimagerie cérébrale Une évaluation de la fonction visuelle, du niveau intellectuel, du profit cognitif et de la fonction motrice, a été effectuée chez treize prématurés âgés de 4 à 14 ans et présentant un trouble visuel liéà une leucomalacie périventriculaire (PVL). Le trouble visuel était caractérisé par une baisse de ľacuité, un décrochage du suivi, des défauts du champ visuel et des troubles de la motilité oculaire. Leur profil cognitif était dysharmonieux avec souvent des scores considérablement plus cleves aux taches verbales qu'aux taches visuo‐spatiales. Neuf enfants avaient une intelligence normale, trois un retard mental leger et un, un retard mental sévère. Chez tous les enfants, le trouble visuel était compliqué par des difficultés visuo‐perceptives, rendant compte ďun plus fort handicap visuel qu'on aurait pu attendre de leur acuité visuelle et du strabisme seuls. Bien que le scanner ct ľIRM. montraient une PVL bilatérale chez tous les enfants, six ne présentaient pas de déficit moteur de type IMC, ce qui est une découverte inattcndue. ZUSAMMENFASSUNG Visuelle Störungen bei Frühgeborenen mit perivenrikulärer Leukomalazie ‐ visuelle, kognitive und neuropädiatrisclie Clwrakleristika in. Relation zu CT und MRT Befunden Bei 13 Frühgeborenen mit visuellen Störungen aufgrund einer periventrikulären Leukomalazie (PVL) wurden im Alter von 4 bis 14 Jahren Sehfunktion, Intelligenzgrad, Wahrnehmungsprofil und Motorfunktion untersucht. Ihre visuelle Stöning war charakterisiert durch gcringe Sehschärfe, Crowding, Gesichtsfeldeinschränkungen und Augenmotilitätsstörungen. Ihr Wahnehmungsprofil war unterschiedlich, häufig mit erhcblich höheren Scores bei den verbalen als bei den visucllräumlichen Aufgaben. Neun hatten eine normale Intelligenz, drei warcn leicht retardiert und eins hatte eine schwere geistige Behinderung. Bei allen Kindern war die visuelle Befund durch eine visuelle Perzeptionsstörung kompliziert. die für ihre größere visuelle Behinderung verantwortlic...

A prospective population based study including 260 children with a birth weight of 1500 g or less was performed in the Stockholm county. The total incidence of retinopathy of prematurity (ROP) was 40*4%, while severe ROP -that is, stage 3 or more, was seen in 20.0%. Cryotherapy was performed in 10.8%. Logistic regression analysis revealed independent association of both gestational age and birth weight with ROP. The association of gestational age and ROP was significantly stronger, indicating that the degree of immaturity of the eye is a main predictive factor for the development of ROP. The purpose of a general screening for ROP is to identify children requiring cryotherapy. Based on these results it seems appropriate to include children with a gestational age of 32 weeks or less in such a programme and a first examination at 5-6 weeks of postnatal age is suggested. (BrJ Ophthalmol 1993; 77: 417-423)

The objective was to investigate any possible relationship between functional and structural vascular changes in women with low gestational age and/or low birth weight by analyzing the retinal vascular pattern in women with thoroughly documented blood pressure. Retinal vessel morphology was evaluated by digital image analysis of ocular fundus photographs in 47 subjects, aged 23-30 y. The women were allocated into three groups: 1) those born preterm and appropriate for gestational age (AGA), with a median gestational age at birth of 30 wk and a median birth weight of 1250 g (n = 14); 2) those born small for gestational age (SGA) but full term (median 40 wk), with a median birth weight of 2130 g (n = 17), and 3) those born full term, AGA, and with a median birth weight of 3640 g (n = 16). Women born preterm had significantly higher length index for arterioles compared with the other two groups (median 1.11 and 1.08, respectively, p = 0.005). In addition, the preterm-born women had significantly fewer number of vascular branching points compared with the controls (median 27 and 30, respectively, p = 0.03). The abnormal retinal vascularization observed in ex-preterm women together with an increased casual blood pressure observed in these subjects suggests that being born preterm does have effects on the vascular system that persist into adult life. In addition, it demonstrates that preterm birth seems to affect the vascular system both functionally and structurally, which, in adulthood, could result in a lower threshold for the development of vascular disease.

The aim of the study was to describe ocular motility in a sample of 56 patients affected by cerebral visual impairment (CVI) of hypoxic-ischemic origin. The sample consisted of 56 participants (37 males and 19 females), ranging in age from 2 to 16 years. In all cases CVI was associated with MRI-verified damage of the cerebral visual system. A complete ophthalmologic and neurological assessment was performed. Behaviour of gaze was studied in four conditions: during scanning of the surrounding environment, during fixation, execution of saccades, and pursuing. In addition, strabismus, nystagmus, and paroxysmal ocular deviations were evaluated. Ocular motility was studied by video recording the patients' eye motility during orthoptic examination. Each pattern of ocular motility studied revealed profound alterations in all the individuals examined. Typical features of ocular motility in CVI were: paroxysmal ocular deviations (present in 78%); the presence of variable angle strabismus (86%); and defective coordination of saccades (93%). Exploration of the environment and fixation were also impaired (88% and 84%, respectively). Disorders of initiation and performing saccades, absence of smooth pursuit, vergence abnormalities, nystagmus beats, instability of fixation, and difficulty in the systematic exploration of the environment were observed. These abnormalities characterize lack of gaze coordination found in children with brain damage. An early and detailed evaluation of ocular motility in individuals with CVI is important, especially when rehabilitation intervention is intended.