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M. E. Hoehn, M. L. Bratton, N. C. Kerr; Amblyopia in Children with Cranial Nerve Palsies Secondary to Brain Tumors. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4749.
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Early onset visual pathology tends to be more amblyogenic. We evaluated the relationship between age of onset for cranial nerve palsies (CNP) and the development of amblyopia.
We performed a retrospective chart review of 73 children diagnosed with a CNP (III, IV, or VI) associated with a brain tumor who did not have any other ophthalmic diagnoses which would impact visual acuity.
Twenty children developed amblyopia (Group A) and had a mean age of 2.8 years at time of CNP diagnosis (range = 0.42 - 9.75 years, SD 2.3). Fifty-three children did not develop amblyopia (Group B) and had a mean age of 7.9 years at time of CNP diagnosis (range = 0.83 - 17.6 years, SD 4.6). The age at diagnosis was significantly different between the two groups (p < 0.0001). Amblyopia developed in 67% of children age 0-2 years at CNP diagnosis, in 50% at 2-4 years, in 18% at 4-6 years, in 9% at 6-8 years, and in 4% over 8 years. There was no significant difference between the two groups with respect to tumor type, treatment, or motility and strabismus resolution (overall 47% and 11%, respectively).
Children with CNP from brain tumors may be particularly susceptible to amblyopia, as the strabismus from the CNP does not usually resolve. The likelihood of amblyopia in young children suggests a role for more aggressive and/or prophylactic amblyopia therapy in children under 4 years of age who develop CNP. Younger children who develop CNP secondary to brain tumors are at high risk for developing amblyopia.
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