Visual Presentation and Factors Affecting Visual Outcome in Children with Craniopharyngioma in East Coast States of Peninsular Malaysia: A Five-year Review

Abstract

Purpose To describe the visual presentation and factors affecting visual outcome in pediatric patients treated for craniopharyngioma at a referral center in the East Coast states of Peninsular Malaysia. Methodology A retrospective review of medical records of children aged 17 years and below who had been treated for craniopharyngioma in Hospital Universiti Sains Malaysia from January 2014 to December 2018. The data collected included age, gender, presenting symptoms and duration, visual acuity, visual fields, color vision, light brightness, relative afferent pupillary defects, fundus examination and cranial nerves examination. The best corrected visual acuity during presentation, and after a one-year post-operative period, was documented. Records on investigations, surgical procedures, therapeutic modalities and recurrences were also reviewed. Results A total of 11 pediatric patients (22 eyes) were recruited. Fifty percent presented with optic atrophy. The mean duration of the onset of symptoms before consultation was 22.3 (24.5) months. A final best corrected visual acuity of 6/12 (20/40) or better was observed in 50% of the patients. There was a statistically significant association between presenting visual acuity, optic nerve function and visual field defects, and the final visual outcome. Conclusions Visual presentations in our study were fairly similar to previous reported studies. One-third presented late with permanent visual loss. Almost half had significant visual impairment after one-year post-operative period. Significant associations were observed between presenting visual acuity, duration of symptoms, impairment of optic nerve function tests, and visual field defects during presentation, and final visual acuity at one year after treatment.

Visual functions in children with craniopharyngioma at diagnosis: A systematic review

“…� Cohort drawn from the same community as the exposed cohort • Cohort drawn from a different source • No description of the derivation of the non-exposed cohort PLOS ONE https://doi.org/10.1371/journal.pone.0240016.g001 [27,[79][80][81], Israel [82][83][84][85] and Japan [19,[86][87][88]; 3 studies in Canada [10,25,89], Italy [90][91][92] and The Netherlands [93][94][95]; 2 studies in Australia [6,96], Korea [97,98], Saudi Arabia [99,100], Turkey [32,101]; 1 study in Bulgaria [102], Denmark [103], Iran [104], Lithuania [105], Malaysia [7], Romania [106], Spain [107] and Taiwan [108]; and for 1 study the country was not reported [109]. With regard to the included children with CP, 1236 were females and the mean age ranged from 0 [39,93] All studies had a retrospective study design, of which 5 studies also had a prospective follow up [14,25,70,…”

“…In the majority of studies, visual function in children with CP at diagnosis was not a primary outcome measure, but details about visual function at diagnosis could be obtained from tables containing baseline characteristics. Precisely 10 studies reported primarily visual function and/or long term visual ouctomes in children with CP [6,7,10,39,52,53,72,83,102,107]. Table 4 shows the results of the risk of bias assessment by the Newcastle-Ottawa Scale (NOS) for the included studies.…”

“…A total of 46 studies provided data about visual field testing in children with CP (Table 3). Nine authors described which VF test is performed in their study, namely the Humphrey Field Analyzer [6,7,10,84], Goldmann perimetry [6,9,10,72,95,109], Bjerrum screen [6,39], confrontation method [7,10] and/or the red test and large white test objects [9].…”

“…Visual field defects were reported in 426 of 1111 tested children (38.3%). Mohd-Ilham (2019) reported about VF per eye instead of per patient: temporal hemianopia was found in 5 of 22 eyes, scotoma in 3 of 22 eyes, quadrantanopia in 2 of 22 eyes and a constricted VF in 1 of 22 eyes [7]. Five studies reported VF data together with VA data, therefore VF data from these studies could not be extracted [24,59,60,73,96].…”

“…Craniopharyngioma mainly causes visual impairment by direct infiltration and/or compression of the visual pathway. Damage of the visual pathway commonly manifests as decreased visual acuity (VA), visual field (VF) defects, typically bitemporal hemianopia, and/ or abnormal pupillary reponses [5][6][7][8][9][10][11]. Increased intracranial pressure as a result of obstructive mass effect of the tumour can lead to papilledema with subsequent optic atrophy and permanent vision loss as potential complications [8,12,13].…”