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Boruah DK, Dutta HK, Sarma K, Hazarika K, Sharma BK, Goswami A. Normative magnetic resonance imaging measurements of orbital structures in pediatric population of North-Eastern India: A retrospective cross-sectional study. Indian J Ophthalmol 2021; 69:2099-2105. [PMID: 34304186 PMCID: PMC8482914 DOI: 10.4103/ijo.ijo_546_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: The people of Northeast India comprise mostly of Mongoloid descent with characteristic craniofacial features. The purpose of this study was to evaluate the normal orbital structures with MRI and determine normative data in the Northeast Indian pediatric population. Methods: MRI images of the 302 orbits of 151 pediatric patients below 16 years of age were retrospectively evaluated to measure the various orbital structures. Both axial and coronal MRI images were utilized for various orbital measurements. An independent sample t-test was done to compare various orbital data according to the sex and side. Linear regression was also done. Results: The mean age of the pediatric population was 9.64 ± 1.47 years with a male: Female ratio of 1.13:1. The mean interzygomatic line was 88.4 ± 9.09 mm and the interorbital line was 22.18 ± 3.62 mm. The mean thicknesses of medial, lateral, superior, and inferior recti muscles were 2.58 ± 0.46, 2.34 ± 0.42, 2.16 ± 0.40, and 2.53 ± 0.49 mm in males and 2.41 ± 0.41, 2.08 ± 0.34, 2.08 ± 0.46, and 2.46 ± 0.49 mm in females. The mean horizontal orbital, vertical orbital diameters, orbital index, mean volume of eyeball, and orbital cavity were 30.27 ± 2.97,3 7.06 ± 3.57, 122.58 ± 7.39, 4.63 ± 0.84, and 15.29 ± 3.52 in males, while 29.16 ± 3.23, 34.96 ± 3.99,119.96 ± 7.31, 4.49 ± 0.87, and 14.65 ± 3.47 in females, respectively. With an increase in age, the interzygomatic line (r = 0.883, r2 = 0.780; P < 0.0005), anterior medial interorbital line (r = 0.808, r2 = 0.652; P < 0.0005), mean volume of eyeball (r = 0.915, r2 = 0.838; P < 0.0005), orbital cavity (r = 0.924, r2 = 0.854; P < 0.0005), and distance between the optic nerve entry site (r = 0.829, r2 = 0.687; P < 0.0005) were increased. Conclusion: This study provides normative data of various orbital structures in a pediatric population and these data likely to be useful for diagnosing various pediatric orbital disorders and helps in the planning of various surgical procedures of orbits.
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Affiliation(s)
- Deb K Boruah
- Department of Radio-Diagnosis, Tezpur Medical College, Sonitpur, Assam, India
| | - Hemonta K Dutta
- Department of Pediatric Surgery, Assam Medical College, Dibrugarh, Assam, India
| | - Kalyan Sarma
- Department of Neuroradiology, All India Institute of Medical Science, New Delhi, India
| | - Karuna Hazarika
- Department of Radio-Diagnosis, Tezpur Medical College, Sonitpur, Assam, India
| | - Barun K Sharma
- Department of Radio-Diagnosis, Sikkim Institute of Medical Science, Gangtok, Sikkim, India
| | - Ananya Goswami
- Dr Rajendra Prasad Centre of Ophthalmic Sciences, All India Institute of Medical Science, New Delhi, India
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Kruglyakova J, Garcia-Filion P, Nelson M, Borchert M. Orbital MRI versus fundus photography in the diagnosis of optic nerve hypoplasia and prediction of vision. Br J Ophthalmol 2020; 104:1458-1461. [PMID: 32024653 DOI: 10.1136/bjophthalmol-2019-315524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION In patients with optic nerve hypoplasia (ONH), the visualisation of the optic disc can be challenging and the definitive diagnosis difficult to ascertain without fundus photography. The use of MRI for diagnosis has been reported as a diagnostic alternative with conflicting results. We retrospectively analysed a disease registry to determine the reliability of orbital MRI measurements of the optic nerve diameter to diagnose ONH, and the correlation with vision outcomes. MATERIALS AND METHODS From a cohort of 140 patients with ONH (13% unilateral) that had reached age 5 years, we identified 43 subjects who had orbital MRI in addition to fundus photography performed prior to 2 years of age. We compared measurements of the optic nerve diameter from orbital MRI scans to the standard relative optic disc size (disc diameter/disc-macula (DD/DM) distance) by fundus photography. All patients had visual acuity tested at age 5 years. Spearman's correlation coefficient was used to determine the correlation of orbital MRI measurements and fundus photography with the diagnosis of ONH, and with vision outcomes. RESULTS Relative disc size (DD/DM)<0.35 showed 100% sensitivity and 100% specificity for the diagnostic confirmation of ONH. The optic nerve diameter measurements by orbital MRI displayed a moderate correlation (rs=0.471; p<0.001) with DD/DM and moderate sensitivity for the diagnosis of ONH. Final visual acuity correlated well with DD/DM measurements by fundus photography (rs=-0.869; p<0.001) and moderately with optic nerve diameter by orbital MRI (rs=-0.635; p<0.001). DISCUSSION Orbital optic nerve diameter from MRI scans has moderate reliability in diagnosing ONH and predicting vision outcomes. Fundus photography for measurements of the optic nerve size should remain the reference for diagnostic confirmation of ONH. These data further support the prognostic value of fundus photography for eventual vision outcomes in this population.
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Affiliation(s)
| | | | - Marvin Nelson
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Mark Borchert
- Department of Ophthalmology, USC Childrens Hospital Los Angeles, Los Angeles, California, USA
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Janthanimi P, Dumrongpisutikul N. Pediatric optic nerve and optic nerve sheath diameter on magnetic resonance imaging. Pediatr Radiol 2019; 49:1071-1077. [PMID: 31049608 DOI: 10.1007/s00247-019-04404-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 01/25/2019] [Accepted: 04/03/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The normal values of optic nerve diameter and optic nerve sheath diameter might be beneficial in defining an abnormality such as optic nerve hypoplasia, or enlarged subarachnoid space, reflecting the state of increased intracranial pressure. OBJECTIVE To study the normal optic nerve diameter and optic nerve sheath diameter on magnetic resonance imaging (MRI) in the early years of postnatal visual development from MRI of the brain. MATERIALS AND METHODS MRI of the brain in patients ages 4 years and younger were gathered. Forty-two studies with normal intracranial findings and a lack of history of increased intracranial pressure were retrospectively reviewed by two reviewers using axial T2-weighted images. Measurements were performed in transverse diameter perpendicular to the optic nerve at 3 mm behind the globe. RESULTS The mean optic nerve diameter of the 77 optic nerves were 2.5 mm (95% confidence interval [CI] 2.4-2.6). The mean optic nerve sheath diameter values of the 79 optic nerve sheath complexes were 5.0 mm (95% CI 4.9-5.1). The mean±standard deviation optic nerve diameter and optic nerve sheath diameter stratified by each age groups were, respectively, 0 to <1 year: 2.3±0.40 and 4.81±0.37; 1 to <2 years: 2.6±0.2 and 5.0±0.4; 2 to <3 years: 2.4±0.3 and 4.9±0.6, and 3 to <4 years: 2.9±0.4 and 5.2±0.60 mm. CONCLUSION Seventy-four of the 77 measurements (96%) were of the measurements were above the threshold of 2 mm for optic nerve diameter. Seventy-seven of the 79 measurements (97%) were of the measurements were below the threshold of 6 mm for optic nerve sheath diameter.
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Affiliation(s)
- Pun Janthanimi
- Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Netsiri Dumrongpisutikul
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
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Al-Haddad CE, Sebaaly MG, Tutunji RN, Mehanna CJ, Saaybi SR, Khamis AM, Hourani RG. Optic Nerve Measurement on MRI in the Pediatric Population: Normative Values and Correlations. AJNR Am J Neuroradiol 2018; 39:369-374. [PMID: 29217740 DOI: 10.3174/ajnr.a5456] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/13/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Few articles in the literature have looked at the diameter of the optic nerve on MR imaging, especially in children, in whom observations are subjective and no normative data exist. The aim of this study was to establish a data base for optic nerve diameter measurements on MR imaging in the pediatric population. MATERIALS AND METHODS This was a retrospective study on the MR imaging of pediatric subjects (younger than 18 years of age) at the Department of Diagnostic Radiology at the American University of Beirut Medical Center, Beirut, Lebanon. The optic nerve measurements were obtained by 3 raters on axial and coronal sections at 3 mm (retrobulbar) and 7 mm (intraorbital) posterior to the lamina cribrosa. RESULTS Of 211 scans of patients (422 optic nerves), 377 optic nerves were measured and included. Ninety-four patients were female (45%) and the median age at MR imaging was 8.6 years (interquartile range, 3.9-13.3 years). Optic nerves were divided into 5 age groups: 0-6 months (n = 18), 6 months-2 years (n = 44), 2-6 years (n = 86), 6-12 years (n = 120), and 12-18 years (n = 109). An increase in optic nerve diameter was observed with age, especially in the first 2 years of life. Measurements did not differ with eye laterality or sex. CONCLUSIONS We report normative values of optic nerve diameter measured on MR imaging in children from birth to 18 years of age. A rapid increase in optic nerve diameter was demonstrated during the first 2 years of life, followed by a slower increase. This was independent of sex or eye laterality.
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Affiliation(s)
- C E Al-Haddad
- From the Departments of Ophthalmology (C.E.A.-H., C.J.M.)
| | - M G Sebaaly
- Diagnostic Radiology (M.G.S., R.N.T., A.M.K., R.G.H.)
| | - R N Tutunji
- Diagnostic Radiology (M.G.S., R.N.T., A.M.K., R.G.H.)
| | - C J Mehanna
- From the Departments of Ophthalmology (C.E.A.-H., C.J.M.)
| | - S R Saaybi
- Pediatrics (S.R.S.), American University of Beirut Medical Center, Beirut, Lebanon
| | - A M Khamis
- Diagnostic Radiology (M.G.S., R.N.T., A.M.K., R.G.H.)
| | - R G Hourani
- Diagnostic Radiology (M.G.S., R.N.T., A.M.K., R.G.H.)
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Lenhart PD, Desai NK, Bruce BB, Hutchinson AK, Lambert SR. The role of magnetic resonance imaging in diagnosing optic nerve hypoplasia. Am J Ophthalmol 2014; 158:1164-1171.e2. [PMID: 25128595 PMCID: PMC4252492 DOI: 10.1016/j.ajo.2014.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To establish objective lower limits of normal optic nerve (ON) size in children based on high-resolution orbital magnetic resonance imaging (MRI). DESIGN Case-control study of patients with ON hypoplasia vs normal controls. METHODS A neuroradiologist made 4 measurements of each ON at 2 locations (5 mm posterior to the optic disc and just posterior to the optic canal) in patients with ON hypoplasia and controls aged 0-17 years from an academic eye center and children's hospital. Primary analyses were performed using mixed linear models. RESULTS Measurements were made in 26 cases of clinically confirmed ON hypoplasia and 31 controls (median age: ON hypoplasia, 1 year; controls, 5.5 years). Nine of 26 cases (35%) and 19 of 31 controls (61%) underwent high-resolution T2-weighted imaging of the orbits. Mean ON diameter was 1.36 mm (95% CI: 1.19-1.54; P < .001) smaller for clinically hypoplastic ONs than for controls. Optic nerve diameter increased by 0.05 mm per year of age (95% CI: 0.03-0.07; P < .001). A lower bound to the 95% prediction interval for normal optic nerves was (2.24 mm + 0.052 × [age in years]) mm and excluded all but 1 case. CONCLUSIONS Age was independently associated with normal ON size by MRI and should be taken into consideration when evaluating ON hypoplasia, based on MRI criteria. We have provided a formula to assist clinicians in objectively determining if ON hypoplasia is present.
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Affiliation(s)
- Phoebe D Lenhart
- Department of Ophthalmology, Division of Pediatric Ophthalmology and Strabismus, Emory University School of Medicine, Emory Eye Center, Atlanta, Georgia.
| | - Nilesh K Desai
- Department of Radiology, Division of Neuroradiology, Emory University School of Medicine, Atlanta, Georgia
| | - Beau B Bruce
- Department of Ophthalmology, Division of Neuro-Ophthalmology, Emory University School of Medicine, Emory Eye Center, Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, Georgia
| | - Amy K Hutchinson
- Department of Ophthalmology, Division of Pediatric Ophthalmology and Strabismus, Emory University School of Medicine, Emory Eye Center, Atlanta, Georgia
| | - Scott R Lambert
- Department of Ophthalmology, Division of Pediatric Ophthalmology and Strabismus, Emory University School of Medicine, Emory Eye Center, Atlanta, Georgia
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Amador-Patarroyo MJ, Pérez-Rueda MA, Tellez CH. Congenital anomalies of the optic nerve. Saudi J Ophthalmol 2014; 29:32-8. [PMID: 25859137 DOI: 10.1016/j.sjopt.2014.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 11/15/2022] Open
Abstract
Congenital optic nerve head anomalies are a group of structural malformations of the optic nerve head and surrounding tissues, which may cause congenital visual impairment and blindness. Each entity in this group of optic nerve anomalies has individually become more prevalent as our ability to differentiate between them has improved due to better characterization of cases. Access to better medical technology (e.g., neuroimaging and genetic analysis advances in recent years) has helped to expand our knowledge of these abnormalities. However, visual impairment may not be the only problem in these patients, some of these entities will be related to ophthalmologic, neurologic and systemic features that will help the physician to identify and predict possible outcomes in these patients, which sometimes may be life-threatening. Herein we present helpful hints, associations and management (when plausible) for them.
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Affiliation(s)
- Manuel J Amador-Patarroyo
- Department of Strabismus, Neuro-Ophthalmology and Ocular Electrophysiology, Escuela Superior de Oftalmología - Instituto Barraquer de América, Bogotá DC, Colombia
| | - Mario A Pérez-Rueda
- Department of Strabismus, Neuro-Ophthalmology and Ocular Electrophysiology, Escuela Superior de Oftalmología - Instituto Barraquer de América, Bogotá DC, Colombia
| | - Carlos H Tellez
- Department of Strabismus, Neuro-Ophthalmology and Ocular Electrophysiology, Escuela Superior de Oftalmología - Instituto Barraquer de América, Bogotá DC, Colombia
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Abstract
Optic nerve hypoplasia (ONH) is a congenital anomaly of the optic disc that might result in moderate to severe vision loss in children. With a vast number of cases now being reported, the rarity of ONH is obviously now refuted. The major aspects of ophthalmic evaluation of an infant with possible ONH are visual assessment, fundus examination, and visual electrophysiology. Characteristically, the disc is small, there is a peripapillary double-ring sign, vascular tortuosity, and thinning of the nerve fiber layer. A patient with ONH should be assessed for presence of neurologic, radiologic, and endocrine associations. There may be maternal associations like premature births, fetal alcohol syndrome, maternal diabetes. Systemic associations in the child include endocrine abnormalities, developmental delay, cerebral palsy, and seizures. Besides the hypoplastic optic nerve and chiasm, neuroimaging shows abnormalities in ventricles or white- or gray-matter development, septo-optic dysplasia, hydrocephalus, and corpus callosum abnormalities. There is a greater incidence of clinical neurologic abnormalities in patients with bilateral ONH (65%) than patients with unilateral ONH. We present a review on the available literature on the same to urge caution in our clinical practice when dealing with patients with ONH. Fundus photography, ocular coherence tomography, visual field testing, color vision evaluation, neuroimaging, endocrinology consultation with or without genetic testing are helpful in the diagnosis and management of ONH. (Method of search: MEDLINE, PUBMED).
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Affiliation(s)
- Savleen Kaur
- Department of Ophthalmology, Guru Nanak Eye Center, New Delhi, India
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Optic nerve hypoplasia syndrome: a review of the epidemiology and clinical associations. Curr Treat Options Neurol 2013; 15:78-89. [PMID: 23233151 DOI: 10.1007/s11940-012-0209-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OPINION STATEMENT BACKGROUND Optic nerve hypoplasia (ONH) has developed into a leading cause of congenital blindness. The frequently associated features of hypopituitarism and absent septum pellucidum were felt to have embryonic linkage as "septo-optic dysplasia" or "de Morsier's syndrome." More recent studies have suggested these associations are independent of one another. This review provides an assessment of the historical and recent evidence linking neuroradiologic, endocrinologic and developmental morbidity in patients with ONH. The prenatal risk factors, heritability, and genetic mutations associated with ONH are described. RESULTS Recognition of the critical association of ONH with hypopituitarism should be attributed to William Hoyt, not Georges de Morsier. De Morsier never described a case of ONH or recognized its association with hypopituitarism or missing septum pellucidum. Hypopituitarism is caused by hypothalamic dysfunction. This, and other more recently identified associations with ONH, such as developmental delay and autism, are independent of septum pellucidum development. Other common neuroradiographic associations such as corpus callosum hypoplasia, gyrus dysplasia, and cortical heterotopia may have prognostic significance. The predominant prenatal risk factors for ONH are primiparity and young maternal age. Presumed risk factors such as prenatal exposure to drugs and alcohol are not supported by scrutiny of the literature. Heritability and identified gene mutations in cases of ONH are rare. CONCLUSION Children with ONH require monitoring for many systemic, developmental, and even life-threatening problems independent of the severity of ONH and presence of brain malformations including abnormalities of the septum pellucidum. "Septo-optic dysplasia" and "de Morsier's syndrome" are historically inaccurate and clinically misleading terms.
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Abstract
BACKGROUND Optic nerve hypoplasia (ONH) has been described as an increasingly prevalent cause of congenital blindness. Its association with hypopituitarism and absent septum pellucidum has been recognized for more than 40 years as "septo-optic dysplasia" or "de Morsier syndrome." More recent studies have suggested that these associations are independent of one another. This review was designed to assess the historical and recent evidence for associations of neuroradiologic, endocrinologic, and developmental problems in patients with ONH. EVIDENCE ACQUISITION Historical and contemporary literature review. RESULTS The medical literature does not support the notion that Georges de Morsier ever described a case of ONH or recognized its association with hypopituitarism or missing septum pellucidum. Recognition of the critical association of ONH with hypopituitarism should be attributed to William Hoyt. Hypopituitarism and other more recently identified associations with ONH, such as developmental delay, hypothalamic dysfunction, and autism, are independent of septum pellucidum development. Other common neuroradiographic associations, such as corpus callosum hypoplasia, gyrus dysplasia, and cortical heterotopia, may have prognostic significance. CONCLUSIONS Children with ONH need to be monitored for many systemic, developmental, and even life-threatening problems independent of the status of the septum pellucidum. "Septo-optic dysplasia" and "de Morsier syndrome" are historically inaccurate and clinically misleading terms that should be abandoned.
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Salmela MB, Cauley KA, Nickerson JP, Koski CJ, Filippi CG. Magnetic resonance diffusion tensor imaging (MRDTI) and tractography in children with septo-optic dysplasia. Pediatr Radiol 2010; 40:708-13. [PMID: 19998031 DOI: 10.1007/s00247-009-1478-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 11/02/2009] [Accepted: 11/13/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Septo-optic dysplasia (SOD) refers to a heterogeneous group of midline brain developmental anomalies, with optic nerve hypoplasia (ONH) being one of the morphologic correlates of the condition. Traditionally, ONH has been diagnosed on fundoscopic exam. Conventional MRI is used in cases of suspected ONH to identify associated brain abnormalities and to compare findings to the fundoscopic exam. Advances in magnetic resonance diffusion tensor imaging (MRDTI) permit in vivo, noninvasive, quantitative characterization of the entire visual pathway at 3.0 T. OBJECTIVE To investigate the feasibility of MRDTI at 3.0 T in children with SOD to evaluate the entire visual pathway. MATERIALS AND METHODS MRDTI at 3T was performed in two children with SOD and seven age-matched controls. Manual region-of-interest analysis was used to evaluate the tensor metrics of the optic nerves. Deterministic tractography was used to evaluate the tensor metrics of the optic radiations. RESULTS The SOD patients demonstrated a significant decrease in anisotropy and increase in mean diffusivity of the optic nerves and radiations compared to the control subjects. CONCLUSION This study demonstrates the feasibility of MRDTI to evaluate the entire visual pathway in children, and it demonstrates pre- and post-chiasmatic diffusion tensor abnormalities in SOD patients.
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Affiliation(s)
- Michael B Salmela
- University of Vermont College of Medicine-Fletcher Allen Health Care, 111 Colchester Ave., Burlington, VT 05401, USA.
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Takagi M, Abe H, Hatase T, Yaoeda K, Miki A, Shirakashi M. Superior segmental optic nerve hypoplasia in youth. Jpn J Ophthalmol 2008; 52:468-474. [DOI: 10.1007/s10384-008-0588-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 07/10/2008] [Indexed: 10/21/2022]
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Sowka J, Vollmer L, Reynolds S. Superior segmental optic nerve hypoplasia: The topless disc syndrome. ACTA ACUST UNITED AC 2008; 79:576-80. [PMID: 18922493 DOI: 10.1016/j.optm.2008.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 04/22/2008] [Accepted: 05/01/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Optic nerve hypoplasia is a well-known congenital maldevelopment presenting with an abnormally small optic nerve head occupying the central aspect of a normally sized chorioscleral canal. Characteristically, the optic nerve head is surrounded by scleral anlage with a "double ring sign." Less commonly appreciated, however, is the fact that optic nerve hypoplasia may be sectorial rather than total and involving only the superior aspect of the optic disc with corresponding inferior visual field loss. CASE REPORT A 51-year-old woman presented with a previous diagnosis of idiopathic optic atrophy superiorly in the left eye. Detailed observation revealed that the disc was not atrophic superiorly but actually hypoplastic, and the patient received a conclusive diagnosis of superior segmental optic nerve hypoplasia. CONCLUSIONS It must be appreciated that optic nerve hypoplasia can also affect solely the superior aspect of the disc with subsequent functional deficits. It is important to differentiate this syndrome from true optic atrophy to ensure proper management.
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Affiliation(s)
- Joseph Sowka
- Nova Southeastern University, Ft. Lauderdale, Florida 33328, USA
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Abstract
PURPOSE A case of optic nerve hypoplasia (ONH) is reported to demonstrate the value of the Heidelberg Retinal Tomograph II (HRT) in assisting with the diagnosis. CASE REPORT An 8-year-old black male was referred to our clinic for evaluation of right esotropia and presumed amblyopia. Best-corrected visual acuities were 20/60 OD (right eye) and 20/25 OS (left eye). Cover test showed constant right esotropia, measuring 10 at distance and 16 at near. A smaller optic nerve head was detected OD with absence of the double ring sign. The findings of HRT were consistent with a diagnosis of unilateral ONH, with a disc area of 1.545 mm OD vs. 2.527 mm OS. DISCUSSION The clinical features, management, and associations of ONH are discussed. CONCLUSION HRT is a useful tool to assist in diagnosis of ONH by physically measuring the optic nerve.
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Baeteman C, Denis D, Loudot C, Toesca E, Bronsard J, Benso C, Fogliarini C, Hadjadj E, Antoniotti S, Chabrol B, Mancini J, Girard N. [Primary exotropia: importance of cerebral MRI]. J Fr Ophtalmol 2008; 31:287-94. [PMID: 18404123 DOI: 10.1016/s0181-5512(08)74807-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Primary exotropia is a divergent strabismus that appears from the first day of life to the second year. It can be isolated or associated with a pathological context requiring cerebral imaging to determine diagnosis and prognosis. The objective of this study was to report the sensorimotor state and the result of MRI in infantile exotropia. PATIENTS AND METHOD Forty-seven children with primary exotropia had a complete ophthalmologic assessment (visual acuity, binocular vision, refraction with cycloplegia, eye fundus) and cerebral MRI (average age, 16 months). Deviation was classified into four categories<4 degrees, > or =4<10 degrees, > or =10<20 degrees, > or =20 degrees. MRI results were classified into seven categories: white matter abnormalities (gliosis, delay of maturation, periventricular leukomalacia, aspecific hyperintense signal, and necroses); Virchow-Robin enlargement space and enlarged subarachnoid space; gray matter abnormalities (necroses, cerebral atrophy, occipital cortex, basal ganglia); ventriculomegaly; thin corpus callosum; cerebellar injury; and tumor. RESULTS There was a statistically significant increase in the rate of pathological MRI as the angle deviation increased: 76.6% of patients had a pathological ophthalmologic exam (amblyopia, ptosis, head posture, Duane's syndrome, cataract, albinism, or pigmentary retinopathy). We found 38% nystagmus and 38% optic nerve hypoplasia. There was a real pathological context in 61.7% of the exotropia cases: 27.7% prematurity, 31.9% fetal distress, 21.3% facial dysmorphy (plagiocephaly), 12.8% psychomotor delay, and 14.9% epilepsy. Only three children had isolated exotropia. Thirty-four cerebral MRI (72.3%) were not normal. In pathological MRI, there was 61.8% white matter injury, 41.2% gray matter injury, and 17.6% thin corpus callosum. CONCLUSION This study demonstrates the fundamental contribution of cerebral MRI in infantile exotropia. The greater the deviation, the more abnormal the MRI results are. The pathological context and ophthalmological abnormalities are important in infantile exotropia.
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Affiliation(s)
- C Baeteman
- Service d'Ophtalmologie pédiatrique et générale, Hôpital Nord, Marseille.
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McCulloch DL, Garcia-Filion P, Garcia-Fillion P, van Boemel GB, Borchert MS. Retinal function in infants with optic nerve hypoplasia: electroretinograms to large patterns and photopic flash. Eye (Lond) 2006; 21:712-20. [PMID: 16601748 DOI: 10.1038/sj.eye.6702309] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIMS Optic nerve hypoplasia (ONH), which is defined as a congenital deficiency of retinal ganglion cells, may also involve more distal layers of the retina. We investigated electrophysiological function of the retina in ONH using electroretinograms (ERGs). METHODS ERGs were recorded from 48 subjects (3.5-35 months) with unilateral or bilateral ONH. Pattern reversal (4 degrees checks) was presented under chloral hydrate sedation, using an optical system to correct a cycloplegic refraction. A photopic flash stimulus was also used. Fundus photographs were used to measure the disk diameter/disk macula ratio (DD/DM), and to document other clinical signs. Eyes were classified as moderate (0.15-0.3) or severe (<0.15) ONH, and those with DD/DM greater than 0.3 were used as reference eyes. RESULTS Pattern ERG recording was completed in 89 eyes and was detectable in 80% of eyes with ONH (61/76 tested) and in all 13 reference eyes. Photopic flash ERGs were of good quality in all eyes. The severity of ONH correlates with the amplitude of the photopic flash b-waves and with the amplitude of the N95 component of the pattern ERG (P<0.01). However, the ERGs to large patterns were well preserved (>3.5 microV) in 10 of 35 eyes with severe ONH. Tortuous retinal vessels in eyes with either moderate or severe ONH were associated with smaller amplitude photopic b-waves and markedly diminished or undetectable pattern ERGs. CONCLUSIONS This study supports the hypothesis that retinal dysfunction distal to the ganglion cells is common in ONH, but is not predictable on the basis of ONH severity alone. Additionally, tortuous retinal vessels in ONH may be a sign associated with retinal dysfunction.
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Affiliation(s)
- D L McCulloch
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Lanarkshire, UK.
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17
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Abstract
In the 2004 Bowman Lecture, I give a panegyric for Sir William Bowman, an estimate of the importance and the epidemiology of anterior visual pathway developmental disorders, followed by a history of the anterior visual system. I review the normal development of the optic nerve and chiasm and the main developmental disorders: Optic Nerve Aplasia, Optic Nerve Hypoplasia and Achiasmia.
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Affiliation(s)
- D Taylor
- Institute of Child Health, London WC1N IEH, UK.
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18
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Abstract
The principal congenital abnormalities of the optic disc that can significantly impair visual function are excavation of the optic disc and optic nerve hypoplasia. The excavated optic disc abnormalities comprise optic disc coloboma, morning glory syndrome, and peripapillary staphyloma. Optic nerve hypoplasia manifests as a small optic nerve, which may or may not be accompanied by a peripapillary ring (the double ring sign). In addition, the optic disc cupping, which occurs as a sequel to some cases of periventricular leucomalacia, can arguably be classified as a type of optic nerve hypoplasia. All of these conditions can be unilateral or bilateral and can impair visual function mildly or severely. It is essential that children with poor vision due to any of these conditions are managed by treating refractive errors, giving occlusion therapy in selected cases, and optimising the conditions at home and at school in an attempt to ensure that impaired vision does not impede development or education.
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Affiliation(s)
- G N Dutton
- Tennent Institute of Ophthalmology, Gartnavel, General Hospital, Glasgow, UK.
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Birkebaek NH, Patel L, Wright NB, Grigg JR, Sinha S, Hall CM, Price DA, Lloyd IC, Clayton PE. Optic nerve size evaluated by magnetic resonance imaging in children with optic nerve hypoplasia, multiple pituitary hormone deficiency, isolated growth hormone deficiency, and idiopathic short stature. J Pediatr 2004; 145:536-41. [PMID: 15480381 DOI: 10.1016/j.jpeds.2004.06.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To objectively define criteria for intracranial optic nerve (ON) size in ON hypoplasia (ONH) on magnetic resonance imaging (MRI) scans. STUDY DESIGN Intracranial ON sizes from MRI were compared between 46 children with ONH diagnosed by ophthalmoscopy (group 1, isolated ONH, 8 children; and group 2, ONH associated with abnormalities of the hypothalamic-pituitary axis and septum pellucidum, 38 children) and children with multiple pituitary hormone deficiency (group 3, multiple pituitary hormone deficiency, 14 children), isolated growth hormone deficiency (group 4, isolated growth hormone deficiency, 15 children), and idiopathic short stature (group 5, idiopathic short stature, 10 children). Intracranial ON size was determined by the cross-sectional area, calculated as [pi x (1/2) height x (1/2) width]. RESULTS Groups 1 and 2 had lower intracranial ON size than did groups 3, 4, and 5 (P < .001). No patients in groups 3 through 5 who had MRI after 12 months of age (when 95% adult size of ONs is attained) had ONs <2.9 mm 2 . Visual acuity correlated significantly with ON size (P < .01). CONCLUSIONS Magnetic resonance imaging of the ONs with cross-sectional area <2.9 mm 2 in a short child more than 12 months of age, with or without hypothalamic-pituitary axis abnormalities, confirms the clinical diagnosis of ONH.
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