Relationship between ocular and computed tomography findings in patients with spina bifida

Abstract

Objectives: Spina bifida is one of the most common congenital diseases in Turkey and around the world. Despite the developing diagnostic and therapeutic methods, abnormal ocular characteristicsin spina bifida patients are still quite common. We investigated the ocular characteristics of spina bifida patients with and without hydrocephalus.

Methods: We included 37 patients who were previously referred to the Istanbul Bilim University, Department of Ophthalmology and already had computed tomography (CT) scans. We retrospectively investigated the patients’ ophthalmologic findings (refractive errors, strabismus, and optic disc characteristics) and used their recent CT images to measure the Evans ratios (ERs), which indirectly reflect the grade of hydrocephalus. The patients were divided into three groups according to their ERs (ER ≤ 0.3, 0.3-0.5, and ≥ 0.5), and then the ocular characteristics of these groups were compared. In addition, the patients were divided into three groups according to their ages ( ≤ 1 year, 1-3 years, and ≥ 3 years), and the ERs and rates of refraction defects in these groups were compared.

Results: There was no relationship between specific ocular characteristics and ER or between age and ER. However, refraction errors were observed more fr equently as patient age increased.

Conclusions: The degree of hydrocephalus does not affect the ocular characteristics of patients with spina bifida, but emmetropization may be deteriorated in these patients.

Keywords

• Spina bifida
• ocular findings
• computed tomography
• emmetropization

References

1. 1. Fletcher JM, Brei, TJ. Introduction: spina bifida - A multidisciplinary perspective. Dev Disabil Res Rev 2010;16:1-5.
2. 2. Centers for Disease Control and Prevention. National center on birth defects and developmental disabilities. Promoting the health of babies, children, and adults and enhancing the potential for full, productive living. Annual Report, Fiscal Year. 2012.
3. 3. Onrat ST, Seyman H, Konuk M. Incidence of neural tube defects in Afyonkarahisar, Western Turkey. Genet Mol Res 2009;8:154-61.
4. 4. McComb JG. Spinal and cranial neural tube defects. Semin Pediatr Neurol 1997;4:156-66.
5. 5. Biglan AW. Ophthalmologic complications of meningomyelocele: a longitudinal study. Trans Am Ophthalmol Soc 1990;88:389-462.
6. 6. Gaston H. Ophthalmic complications of spina bifida and hydrocephalus. Eye (Lond) 1991;5(Pt 3):279-90.
7. 7. Gaston H. Does the spina bifida clinic need an ophthalmologist? Z Kinderchir 1985;40(Suppl 1):46-50.
8. 8. Kirkpatrick M, Engleman H, Minns RA. Symptoms and signs of progressive hydrocephalus. Arch Dis Child 1989;64:124-8.

9. 9. Caines E, Dahl M, Holmström G. Longterm oculomotor and visual function in spina bifida cystica: a population-based study. Acta Ophthalmol Scand 2007;85:662-6.
10. 10. Hunt GM, Oakeshott P, Kerry S. Link between the CSF shunt and achievement in adults with spina bifida. J Neurol Neurosurg Psychiatry 1999;67:591-5.
11. 11. John W, Sharrard W, Zachary RB, Lorber J, Bruce AM. A controlled trial of immediate and delayed closure of spina bifida cystica. Arch Dis Child 1963;38:18-22.
12. 12. Ambarki K, Israelsson H, Wahlin A, Birgander R, Eklund A, Malm J. Brain ventricular size in healthy elderly: comparison between Evans index and volume measurement. Neurosurgery 2010;67:94-9.
13. 13. American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Preferred Practice Pattern® Guidelines. Pediatric Eye Evaluations. San Francisco, CA: American Academy of Ophthalmology, 2012.
14. 14. Evans WA. An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy. Arch Neur Psych 1942;47:931-7.
15. 15. Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 2005;(3 Suppl):S4-16.
16. 16. Mori E, Ishikawa M, Kato T, Kazui H, Miyake H, Miyajima M, et al; Japanese Society of Normal Pressure Hydrocephalus. Guidelines for management of idiopathic normal pressure hydrocephalus: second edition. Neurol Med Chir (Tokyo) 2012;52:775-809.
17. 17. Marmarou A, Bergsneider M, Relkin N, Klinge P, Black PM. Development of guidelines for idiopathic normal-pressure hydrocephalus: introduction. Neurosurgery 2005;57:S1-3.
18. 18. Ishikawa M. Clinical guidelines for idiopathic normal pressure hydrocephalus. Neurol Med Chir 2004;44:222-3.
19. 19. Stein SC, Schut L. Hydrocephalus in myelomeningocele. Pediatr Neurosurg 1979;5:413-9.
20. 20. Goldschmidt E. Refraction in the newborn. Acta Ophthal 1969;47:570-8.
21. 21. Toygar O, Ogut MS, Kozakoglu H. [Vision screening of school children in Istanbul]. Turk J Ophthalmol 2003;33:585-91. [Article in Turkish]
22. 22. Lennerstrand G, Gallo JE. Neuro‐ophthalmological evaluation of patients with myelomeningocele and chiari malformations. Dev Med Child Neurol 1990;32:415-22.
23. 23. Schaeffel F, Glasser A, Howland HC. Accommodation, refractive error and eye growth in chickens. Vision Res 1988;28:639-57.
24. 24. Altman HE, Hiatt RL, De Weese MW. Ocular findings in ceerebral palsy. South Med J 1966;19:1015-8.
25. 25. McClelland JF, Saunders KJ, Jackson AJ, Parkes J, Hill N. Accommodative dysfunction and refractive anomalies in children with cerebral palsy (CP). Invest Ophthalmol Vis Sci 2004;45:2735.
26. 26. Ross L, Heron G, Mackie R, McWilliam R, Dutton GN. Reduced accommodative function in dyskinetic cerebral palsy: a novel management strategy. Dev Med Child Neurol 2000;42:701-3.
27. 27. Saunders KJ, McClelland JF. Spectacle intervention in children with cerebral palsy (CP) and accommodative dysfunction. Invest Ophthalmol Vis Sci 2004;45:1394.
28. 28. Woodhouse JM, Meades JS, Leat SJ, Saunders KJ. Reduced accommodation in children with Down syndrome. Invest Ophthalmol Vis Sci 1993;34:2382-7.
29. 29. Cregg M, Woodhouse JM, Pakeman VH, Saunders KJ, Gunter HL, Parker M, et al. Accommodation and refractive error in children with Down syndrome: cross-sectional and longitudinal studies. Invest Ophthalmol Vis Sci 2001;42:55-63.
30. 30. Troilo D, Wallman J. The regulation of eye growth and refractive state: an experimental study of emmetropization. Vision Res 1991;31:1237-50.
31. 31. Cumurcu T, Düz C, Gündüz A, Doganay. [The prevalence and distribution of refractive errors in elementary school children in area of Malatya]. İnonu Üniversitesi Tıp Fak Derg 2011;18:145-8. [Article in Turkish]
32. 32. Kasapoğlu E, Eltutar K. [Vision screening results of day nursery of S.B. İstanbul Education and Research Hospital]. İstanbul Tıp Dergisi 2006;7:11-3. [Article in Turkish]
33. 33. Dadacı Z, Öncel Acır N, Borazan M. [Evaluation of refractive disorders and amblyopia in elementary school children admitted to an outpatient ophthalmology clinic]. Ankara Med J 2015;15:140-4. [Article in Turkish]