Ireland has a relatively high rate of spina bifida (SB), with a neural tube defect rate of 1.05 per 1000 births of which 47% are SB. This study was an audit of SB myelomeningocele (SBM) cases over an 8-year period, logging visual outcomes and investigating the influence of spinal lesion level and shunt insertion on outcomes. The study included 129 children with median age of 6.9 years (IQR 7.07) and 69 female, 60 male. Lumbar spinal lesions accounted for 60.5%, sacral for 20.2%, thoracic for 18.6% and occipital for 0.8%. Ventriculo peritoneal (VP) shunts were inserted at a median of 8 days (IQR 17.8) for 67.4%. Median log visual acuity was 0.1 and 18.2% were visually impaired; 9.1% mild, 8.2% moderate and 0.9% severe. Strabismus was present in 33.3% (esotropia>exotropia), 12.4% had papilloedema, 5.4% optic atrophy and 4.7% cortical visual impairment. Of 49 children with cycloplegic refraction, 40.8% had significant refractive error. Visual acuity level was significantly associated with spinal lesion level but not with VP shunt status. Papilloedema was significantly associated with shunt status but it was unknown if this was due to shunt malfunction or pre-existing intracranial pressure abnormality, or number of revisions. The authors conclude that regular ophthalmology assessments are needed for SBM and especially for those with higher level spinal lesions and shunt placements. This will help minimise sight loss from treatable visual conditions.
Visual characteristics of spina bifida myelomeningocele
Reviewed by Fiona Rowe
Ophthalmic outcomes in children with spina bifida myelomeningocele in Ireland.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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