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Nitza Goldenberg-Cohen, Omer Bialer, Helen Toledano, Moshe Snir, Shalom Michowiz; Nerve Fiber Loss In Children With Craniopharyngioma Is In Correlation With Visual Fields Defects. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3929.
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© ARVO (1962-2015); The Authors (2016-present)
Children with craniopharyngioma are usually diagnosed after the development of optic neuropathy. The tumor directly compresses the optic nerve, leading to visual field defects. The common objective measurement is the automated perimetry test, inappropriate for young children or those with poor visual acuity (VA). Recently, the use of peripapillary optical coherent tomography (OCT) may offer an alternative objective method to monitor progressive optic neuropathy. Peripapillary OCT is swift, easy to perform, and is highly correlated to anatomical-functional changes. The aim of this study is to compare repeated OCT measurement in children with craniopharyngiomas and their visual function.
This is a retrospective cohort of children diagnosed with craniopharyngioma in our hospital between 1999-2011. Review of medical records, imaging, and Humphrey visual fields were performed. Peripapillary nerve fiber layer (NFL) thickness measured by OCT was analyzed and compared with VA, VFs, and optic nerve pallor. Differences were analyzed between repeated tests.
20 of 26 children diagnosed with craniopharyngioma were included (10 males, 10 females). The average age at diagnosis was 6.5±3.88 years. The common symptom at diagnosis was a headache. Only one complained of visual loss. BCVA Log Mar was 0.036±0.06 for healthy eyes and 1.05±1.45 for optic neuropathy eyes. Signs were positive RAPD (8/20 children), VA loss (7/20), temporal VF loss (bilateral 4/15, unilateral 4/15), papilledema (3/20) and uni/bilateral optic disc pallor (14/20).Compared with normal eyes, average RNFL thickness was reduced 14-20µm when optic neuropathy existed. There was no change in RNFL thickness over time (mean 18±14.2 months) in seven children after 2 consecutive OCT measurements. NFL thickness and VA or VF-defect were correlated.
Craniopharyngioma leads to optic neuropathy in most pediatric patients. RNFL thickness measurement correlates with such VF defects. Thus, peripapillary OCT may contribute as an objective measurement in the follow-up of these children.
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