Ocular Disorders in Children with Cerebral Palsy

Abstract

ÖzetAmaç: Serebral Palsili (SP) olgularda s›k görülebilen oftalmolojik patolojilerin de¤erlendirilmesi ve gestasyonel yafl, do¤um a¤›rl›¤›, hastal›k tipi, nöroradyolojik bulgularla iliflkisinin incelenmesi. Gereç ve Yöntem: Çal›flmaya SP tan›l› 104 hasta al›nm›flt›r. Hastal›¤›n etiyolojisi irdelenerek, görme keskinli¤i, refraksiyon de¤erlendirilmesi, ortoptik muayene, nistagmus de¤erlendirilmesi ve fundoskopik incelemeleri içeren oftalmolojik muayeneler yap›lm›flt›r. Gestasyonel yafl, do¤um a¤›rl›¤›, hastal›k tiplendirmesi ve nöroradyolojik bulgularla iliflkileri incelenmifltir. Sonuçlar: SP olgular›n›n görsel rehabilitasyonlar›n›n sa¤lanmas› için erken dönemde göz hekimlerine yönlendirilmesi önemlidir. Özellikle düflük gestasyonel yafl ve do¤um a¤›rl›kl›, nöroradyolojik bulgular› bulunan ve spastik diplejik ile spastik tetraplejik klinik tipteki olgular oftalmolojik aç›dan dikkatlice de¤erlendirilmelidir. Tart›flma: ‹lk muayenedeki ortalama yafl 53,0±41,9 ayd›. Etiyolojik faktörün olgular›n %56,7'sinde asfiksik do¤um oldu¤u görüldü. Hastalar›n %84.6's›nda anormal göz bulgular› saptand›. On sekiz olguda (%17,3) nistagmus saptan›rken, 61 olguda (%58.7) flafl›l›k saptand›. Ezotropya grubunda, ekzotropya ve ortoforik gruba göre daha erken gestasyonel haftada ve düflük do¤um a¤›rl›¤›yla do¤um oldu¤u saptand› (p=0.003, p=0.006). Fundoskopide 96 gözde (%46,2) anormal disk morfolojisi saptand›. Hastal›k tiplemesinde olgular›n %41.4'ünün spastik diplejik, %40,4'ünün ise spastik tetraplejik oldu¤u görüldü. Spastik tip SP'ler incelendi¤inde tetraplejik tip SP hastalar›n›n istatistiksel olarak anlaml› flekilde di¤er gruplardan daha düflük görmeye sahip olduklar› saptand› (p=0,039). Anizometropi hastalar›n %18,3'ünde ve yaflla uyumlu olmayan belirgin refraksiyon kusuru 43 olguda (%4,3) izlenirken, bunlardan 28 tanesine (%26,9) muayene sonucunda yeni gözlük reçetelendirildi. Otuz iki olguda (%30,8) nöroradyolojik incelemede a¤›r periventriküler lökomalazi (PVL) saptand›. Nöroradyolojik bulgular ile görme keskinli¤i iliflkisi de¤erlendirildi¤inde, a¤›r PVL saptan›lan olgular›n istatistiksel olarak anlaml› biçimde düflük görmeye sahip olduklar› saptand› (p=0,041). (TOD Dergisi 2010; 40: 209-16) Anahtar Kelimeler: Serebral palsi, oküler problemler, periventriküler lökomalazi, flafl›l›k Summary Purpose: To evaluate the common ocular abnormalities in children with cerebral palsy (CP) and to correlate them with gestational age, birth weight, clinical subtype of CP and neuroradiological findings. Material and Method: 104 patients with CP were enrolled in this study. Detailed ophthalmic examinations including visual acuity, ocular motility, nistagmus and orthoptic assessments, cycloplegic refraction and fundoscopic examinations were performed. The relationship between gestational age, birth weight, clinical subtype of CP, neuroradiological assessments and the results of ocular examinations was evaluated. Results: The mean age was 53.0±41.9 months at the first visit. Etiologic factor was asphyxia in 56.7% of patients. 84.6% of patient...

Prevalence and types of strabismus in cerebral palsy: A global and historical perspective based on a systematic review and meta-analysis

“…1,45,54,94,155,167 Lesions of basal ganglia and cerebellum (dyskinetic and ataxic CP) less often associate with strabismus. 10,36,37,47,105,189…”

“…We also excluded reviews only, case studies, abstracts at meetings when later published as a peerreviewed paper, and papers focused on surgical outcomes. We included 54 studies on Caucasians (most of them in Europe, North America and Australia), 9,10,14,36-42,44,48-53,64-101 11 studies from the Middle East, 5,16,23,[102][103][104][105][106][107][108][109] 9 on Hispanics (most of them from Latin America), 15,[110][111][112][113][114][115][116][117] 41 from East Asia, 12,13,43,46,56,58, 23 from South Asia, 33,35,45,47,54,57,[153][154][155][156][157][158][159][160][161][162][163][164][165][166]…”

“…3,5,37,38,45,46,48,58,70,115,153,159,[198][199][200][201][202] Relatively few authors disagree with this conclusion. 39,74,101 Some authors noted that strabismus is most frequent in spastic tetraplegia (or triplegia) and somewhat less in diplegia, still less in hemiplegia, and rare in athetoid or ataxic CP, 5,11,36,39,40,45,47,64,70,101,105,149,163 while others disagree with this notion. 15,[41][42][43]52,56,67,78,100,111,203 Authors concur that there is no association between the type of strabismus (esotropia, exotropia, hypertropia) and the type of CP.…”

“…1,45,54,94,155,167 Lesions of basal ganglia and cerebellum (dyskinetic and ataxic CP) less often associate with strabismus. 10,36,37,47,105,189 Other authors implicate lesions of cortical or subcortical visual pathways as the primary cause of strabismus in CP. 1,46,56,56,189,208,209 The significance of impaired visual pathways (optic radiations and/or cortical areas involved in visual motion processing) for strabismus in CP is supported by imaging studies (CT, MRI).…”