Visual acuity evaluation in children with hydrocephalus: An electrophysiological study with sweep visual evoked potential

Silvana Alves Pereira, Marcelo Fernandes Costa

Department Psicologia Experimental, Instituto de Psicologia, Universidade de S?o Paulo, S?o Paulo, Brazil.
Núcleo de Neurociências e Comportamento, Universidade de S?o Paulo, S?o Paulo, Brazil.

DOI: 10.4236/wjns.2012.21006                

Abstract

The objective was to measure the visual acuity (VA) of children with the diagnosis of hydrocephalus with or without peritoneal-ventricular shunt (PVS). A total of 55 children were included in the study (34 Female), with an age range of 0 to 291 weeks. The VA was measured by the sweep visual evoked potential technique. Of those with a PVS, in 31 the ventricular valve was inserted before 15 days after the diagnosis whereas in 14 the ventricular valve was inserted after 15 days. The sweep VEP was performed in all children, 95 exams (94%) were abnormal and only 6 were normal. There was a statistical difference in the VA between children with a PVS inserted before 15 days of the diagnosis and children with a PVS after 15 days (p = 0.038) or those without a shunt (p = 0.031). Children with no complications of the PVS had a better VA as compared to those with shunt complications (p < 0.001). In the group of children with complications, again those who had a shunt inserted be-fore 15 days had better VA results in com- parison to those in whom the shunt was inserted after 15 days (p = 0.029). No statistical difference in the VA was found between children without the PVS and with those in which the shunt was inserted after 15 days of the di-agnosis of hydrocephalus (p = 0.699). We conclude that the delayed insertion of the PVS may compromise the visual development of these children.

Keywords

Hydrocephalus; Ventricular Shunt; Visual Acuity; Sweep Visual Evoked Potential; Visual Development

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Tzekov, S. and Cherninkova, T.G. (1991) Neuroophthal- mo-logical symtoms in children treated for internal hy- drocephalus. Pediatric Neurosurgery, 17, 317-320. doi:10.1159/000120617
[2]	Cedzich, C., Schramm, J. and Wenzel, D. (1990) Reversi- ble visual loss after shunt malfunc-tion. Acta Neurochirur- gica, 105, 121-123. doi:10.1007/BF01669994
[3]	Sutton, L.N., Sun, P. and Ad-zick, N.S. (2001) Fetal neu- rosurgery. Neurosurgery, 48, 124-142. doi:10.1097/00006123-200101000-00023
[4]	Biglan, A.W. (1995) Strabismus associated with men- ingomyelocele. Journal of Pediatric Ophthalmology and Strabismus, 32, 309-314.
[5]	Caines, E., Dahl, M. and Holmstro, G. (2007) Longterm oculomotor and visual function in spina bifida cystica: A population-based study. Acta Ophthalmologica Scanddi- navica, 85, 662-666. doi:10.1111/j.1600-0420.2007.00905.x
[6]	Cedzich, C., Schramm, J. and Wenzel, D. (1992) Reversi- ble visual loss after shunt malfunction. Acta Neurochirur- gica, 105, 121-123. doi:10.1007/BF01669994
[7]	Cronemberger, M.F., Tabuse, M.K.U., Aguilar, L.T., Costa, M.F. and Ferraretto, I. (1999) Achados oculares em pacientes com mielomeningocele: 72 casos. Arquivos Brasileiros, Oftalmologia, 63, 379-382. doi:10.1590/S0004-27492000000500010
[8]	Fobe, J.L., Rizzo, A.M.P.P., Silva, I.M., Silva, S.P.M., Teixeira, C.E., Souza, A.M.C. and Fernandes, A. (1999) QI em pacientes com hidrocefalia e mielomeningocele: Implica??es do tratamento cirúrgico. Arquivos de Neuro- Psiquiatria, 57, 44-50. doi:10.1590/S0004-282X1999000100009
[9]	Norcia, A.M. and Tyler, C. (1985) Spatial frequency sweep VEP: Visual acu-ity during the first year of life. Vision Research, 25, 1399-1408. doi:10.1016/0042-6989(85)90217-2
[10]	Costa, M.F., Ventura, D.F., Salom?o, S.R., Berezovsky, A., De Haro, F.M. and Tabuse, M.K.U. (2001) Grating acuity measured by sweep VEP in children with spastic cerebral palsy. Investigative Ophthal-mology & Visual Science, 42, 4536.
[11]	Costa, M.F., Salomao, S.R., Berezovsky, A., De Haro, F.M. and Ventura, D.F. (2004) Relationship between vi- sion and motor impairment in children with spastic cere- bral palsy: New evidence from elec-trophysiology. Behav- ioral Brain Research, 149, 145-150. doi:10.1016/S0166-4328(03)00223-7
[12]	Holladay, J.T. (1997) Proper method for calculating av- erage visual acuity. Journal of Refractive, Surgery, 13, 388-390.
[13]	Heisens-bergen, I., Rottevell, J., Roeleveld, N. and Grot- tenhuis, A. (2002) Outcome in shunted hydrocephalic children. European Journal of Paediatric Neurology, 6, 99-107. doi:10.1053/ejpn.2001.0555
[14]	Paysse, E.A., Khokhar, A., McCreery, K.M.B., Morris, M.C. and Coats, D.K. (2002) Up-slating palpebral fissures and oblique astigmatism associated with a-pattern strabismus and overdepression in adduction in spina bi- fida. Journal of AAPOS, 12, 354-359. doi:10.1067/mpa.2002.129042
[15]	Reinprecht, A., Dietrich, W., Berger, A., Bavinzski, G., Weninger, M. and Czech, T. (2001) Posthemorrhagic hy- drocephalus in preterm infants: Long-term follow-up and shunt-related complications. Child’s Nervous System, 13, 663-669. doi:10.1007/s00381-001-0519-2
[16]	Kliemann, S.E. and Rosemberg, S. (2005) Hidrocefalia derivada na infancia: Um estudo clínico-epidemiológico de 243 observa??es consecutivas. Arquivos de Neuro-Psi- quiatria, 63, 494-501. doi:10.1590/S0004-282X2005000300024
[17]	Vinck, A., Maassen, B., Mullaart, R. and Rotteveel, J. (2006) Ar-nold-Chiari-II malformation and cognitive functioning in spina bifida. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 1083-1086. doi:10.1136/jnnp.2005.075887
[18]	Gabrieli, A.P.T., Vankoski, S., Dias, L.C., Milani, C. and Louren?o A. (2004) Análise laboratorial de marcha na mielomeningocele de nível lombar baixo e instabilidade unilateral de quadril. Acta Or-topédica Brasileira, 12, 91-99.
[19]	Ladewig, I. (2000) A importancia da aten??o na apren- dizagem de habilidades motoras. Revista Brasileira de Educa??o Física e Esporte, 3, 62-71.
[20]	Ventura, D.F., Gualtieri, M., Oliveira, A.G.F., Costa, M.F., Quiros, P., Salom?o, S.R., Berezovsky, A., Sadun, F., Sadun, A.A. and Carelli, V. (2007) Male prevalence for color vision defects in leber’s hereditary optic neu- ropathy. Investigative Ophthalmology & Visual Science, 48, 2362-2370. doi:10.1167/iovs.06-0331
[21]	Costa, M.F., Oliveira, A.G.F., Feitosa-Santana, C., Zatz, M. and Ventura, D.F. (2007) Red-green color vision im- pairment in duchenne muscular dystrophy. American Journal of Human Genetics, 80, 1064-1075. doi:10.1086/518127
[22]	Moura, A.L.A., Teixeira, R.A.A., Oiwa, N.N., Costa, M.F., Callegaro, D., Hamer, R.D. and Ven-tura, D.F. (2008) Chromatic discrimination losses in multiple sclerosis pa- tients with and without optic neuritis using the cam-brigde color test. Visual Neuroscience, 25, 463-468. doi:10.1017/S0952523808080437
[23]	Spencer, R.M.D. (2006) Long-term visual outcomes in extremely low-birth-weight children. Transactions of the American Ophthalmological Society, 104, 493-516.
[24]	Graziano, R.M. and Leone, C.R. (2002) Problemas oftal- mológicos mais freqüentes e desenvolvimento visual do pré-termo extremo. Jornal de Pediatria, 81, 95-100.
[25]	Guerra, A.B., Diniz E.M.A., Krebs, V.L.J., Ceccom, M.E.J., Ferbaum, R., Vaz, F.A.C. and Ramos, J.L.A. (1995) Estudo clínico-evolutivo de 63 recém-nascidos portadores de hemorragia intracraniana. Pediatria, 17, 117-122.
[26]	Shokumbi, M.T., Odebode, T.O., Agbeja-Baiyeroju, A.M., Malomo, A.O., Ogunseyinde, A.O. and Familusi, J.B. (2002) A comparison of visual function scores in hydro- cephalic infants with and without lumbosacral myelo- meningocoele. Eye, 16, 739-743. doi:10.1038/sj.eye.6700085