Cerebral visual impairment in children: Multicentric study determining the causes, associated neurological and ocular findings, and risk factors for severe vision impairment.

Purpose: To evaluate the causes, associated neurological and ocular findings in children with cerebral visual impairment (CVI), and to identify risk factors for severe vision impairment. Methods: A multicenter, retrospective, cross-sectional analysis was carried out from January 2017 to December 2019 on patients less than 16 years of age with a diagnosis of CVI. Results: A total of 405 patients were included of which 61.2% were male and 38.8% were female. The median age at presentation was 4 years (range 3 months to 16 years). Antenatal risk factors were present in 14% of the cases. The most common cause of CVI was hypoxic-ischemic encephalopathy (35.1%), followed by seizure associated with brain damage (31.3%). The most common neurological finding was seizure (50.4%), followed by cerebral palsy (13.6%). Associated ophthalmological findings were significant refractive error (63.2%), esotropia (22.2%), exotropia, (38%), nystagmus (33.3%), and optic nerve atrophy (25.9%). Severe visual impairment (<20/200) was associated with optic atrophy (odds ratio: 2.9, 95% confidence interval: 1.4-6.0; P = 0.003) and seizure disorder (odds ratio: 1.9, 95% confidence interval: 1.2-3.3; P = 0.012). Conclusion: The various ophthalmic, neurological manifestations and etiologies could guide the multidisciplinary team treating the child with CVI in understanding the visual impairment that affects the neuro development of the child and in planning rehabilitation strategies.

Suture Selection for Incision Closure in Pediatric Cataract Surgery: A Dilemma for Pediatric Ophthalmologists.

PURPOSE: To measure and compare suture-related complications in children undergoing cataract surgery with a surgical incision closure performed by either a 10-0 nylon suture followed by suture removal within 1 to 2 weeks after surgery or a 10-0 polyglactin suture left in situ. METHODS: This was a prospective, non-randomized cohort study. All children with bilateral cataracts who underwent cataract surgery with a surgical incision closure by non-absorbable 10-0 nylon sutures followed by suture removal within 1 to 2 weeks after surgery in their first eye and incision closure by absorbable 10-0 polyglactin sutures left in situ after their second eye surgery. The frequency of suture-related complications (vascularization near to suture, loosening of suture, mucus accumulation, early rupture, and infective keratitis) was noted for 10-0 nylon and 10-0 polyglactin sutures. RESULTS: Eighty-two eyes of 41 children were enrolled in the study. All children were observed until 3 months after surgery. Of the 10-0 nylon sutures, 2 (4.9%) were loose and 2 (4.9%) had underlying corneal edema. The remaining sutures (n = 37, 90.2%) were removed within 1 to 2 weeks after surgery. Of the 10-0 polyglactin sutures, 5 (12.2%) were loose, 2 (4.9%) were vascularized, and 3 (7.3%) had mucus infiltration. These sutures (n = 10, 24.3%) were removed 2 to 5 weeks after the second eye surgery. The remaining polyglactin sutures (n = 31, 75.6%) were left in situ. CONCLUSIONS: A higher frequency of suture-related complications was observed with the 10-0 polyglactin sutures than the 10-0 nylon sutures. The authors recommend using 10-0 nylon sutures with suture removal within 1 to 2 weeks after surgery over using 10-0 polyglactin sutures for incision closure in pediatric cataract surgeries. [J Pediatr Ophthalmol Strabismus. 2022;59(4):243-247.].