Abstract
Purpose :
Retrospective case-control evaluation of neuroimaging findings acquired over 8 years in 6 distinct pediatric groups (142 subjects) was performed to objectively analyse whether periventricular white matter changes on magnetic resonance imaging (MRI) in esotropic (ET) subjects denoted perinatal insults, as anecdotally reported.
Methods :
The study cohort comprised developmentally and neurologically normal ET (Group A, n=26, 5.2±3.3 years, 14 males) exotropic (XT, Group B, n=29, 9.1±4.2 years, 14 males) and orthotropic (Group C, n=19, 7.8±4.5 years, 10 males) subjects, as also, children with established perinatal insult and global developmental delay (GDD) presenting with ET (Group D, n=24, 3.3±3.2 years, 17 males), XT (Group E, n=11, 5.8±6.2 years, 7 males) and orthotropia (Group F, n=33, 4.3±3.9 years, 20 males). Sequential brain MRI analysis (1.5T, Siemens Symphony) evaluated gross changes like ventricular dilatation, encephalomalacia and gyral atrophy as well as subtle periventricular and other non-specific white matter changes.
Results :
Structural brain parenchymal changes were ubiquitously seen in all three groups with established GDD though they were significantly less in the orthotropic versus the ET group (p=0.007) and completely absent in the group without GDD irrespective of the presence or type of strabismus. Periventricular white matter changes, while observed in all groups was significantly more in all three GDD groups (Group A versus Group D, ET, p=0.004; Group B versus Group E, XT, p=0.0002; Group C versus Group F, orthotropic, p=0.008). Subjects with orthotropia with no GDD had significantly lesser periventricular changes than those with ET and XT (Group D versus Group F, p=0.006; Group E versus Group F, p=0.02).
Conclusions :
ET subjects with GDD demonstrated significantly more encephalomalacia than orthotropic subjects with GDD. Significantly greater extent of periventricular white matter changes was observed in developmentally and neurologically normal ET and XT subjects versus orthotropic subjects (Figure 1a-f). This novel clinico-radiological spectrum generates thoughts on its role in the genesis of concomitant strabismus in neurologically normal children.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.