RESUMO
Purpose: To assess long-term visual and neurodevelopmental outcomes in children with congenital Zika syndrome (CZS) after strabismus surgery. Methods: A consecutive sample of five children with CZS who underwent strabismus surgery was enrolled. All children underwent a standardized pre- and postoperative protocol including binocular best-corrected visual acuity (BCVA) using the Teller Acuity Cards II (TAC II), ocular alignment, functional vision using the functional vision developmental milestones test (FVDMT), and neurodevelopmental milestone evaluation using the Bayley Scales of Infant Development-Third Edition (BSID-III). Scores of the FVDMT outcomes considering the child's developmental age based on the BSID-III score were compared with scores from postoperative assessment. Results: Five children with CZS (3 girls, 2 boys) were enrolled with a mean age at baseline (preoperative) of 35.0 ± 0.7 months (range, 34-36 months) and at final assessment of 64.4 ± 0.5 months (range, 64-65 months). Preoperative BCVA was 1.2 ± 0.5 logMAR and at final assessment 0.7 ± 0.1 logMAR. Successful strabismus surgery outcome was maintained in 4/5 (80.0%) of children at final assessment. The children's BSID-III scores showed significant neurodevelopment delay at the initial assessment (corresponding developmental mean age was 4.7 months) and at their final assessment (corresponding developmental mean age was 5.1 months). There was improvement or stability in 34/46 items evaluated in the FVDMT (73.9%) when comparing baseline with 2-year follow-up. Conclusions: Strabismus surgery resulted in long-term ocular alignment in the majority of children with CZS. All the children showed improvement or stability in more than 70.0% of the functional vision items assessed. Visual and neurodevelopmental dysfunction may be related to complex condition and associated disorders seen in CZS including ocular, neurological, and skeletal abnormalities.
Assuntos
Procedimentos Cirúrgicos Oftalmológicos , Estrabismo , Acuidade Visual , Infecção por Zika virus , Humanos , Feminino , Masculino , Estrabismo/cirurgia , Estrabismo/fisiopatologia , Pré-Escolar , Infecção por Zika virus/complicações , Acuidade Visual/fisiologia , Seguimentos , Músculos Oculomotores/cirurgia , Músculos Oculomotores/fisiopatologia , Visão Binocular/fisiologia , Transtornos do Neurodesenvolvimento/etiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
The inconsistency in terminology for Cortical Visual Impairment or Cerebral Visual Impairment presents challenges: (1) different levels of changes in visual pathway and other cerebral areas do not allow discrimination; (2) different visual and oculomotor aspects are not adequately considered. We open a debate to consider a more appropriate diagnosis.
Assuntos
Terminologia como Assunto , Transtornos da Visão , Humanos , Transtornos da Visão/fisiopatologia , Transtornos da Visão/diagnóstico , Córtex Visual/fisiologia , Vias Visuais/fisiopatologiaRESUMO
La prematuridad extrema constituye un riesgo importante para la función visual, no sólo por los efectos potencialmente devastadores para el ojo de la retinopatía del prematuro, que puede llegar a la ceguera, sino porque se asocia además al desarrollo de miopía, estrabismo y déficit visual cerebral. A medida que sobreviven cada día prematuros más extremos por la mejoría del cuidado neonatal, estas patologías derivadas de la prematuridad aumentan en prevalencia en la población infantil. Hoy en día, la retinopatía del prematuro es la primera causa de ceguera infantil en los países en desarrollo como el nuestro. Aquellos niños que no quedan ciegos por ella, pueden presentar las otras complicaciones quedando con algún grado de déficit visual. La ceguera, o incluso limitación visual de un niño genera muchos más años de discapacidad que una catarata, un glaucoma o una maculopatía, patologías que se presentan en general en los últimos años de vida. Por esto, las patologías y secuelas oculares de la prematuridad deben ser pesquisadas y tratadas a tiempo, y así minimizar su proyección sobre la vida del niño y del adulto que llegará a ser. El propósito de este artículo es revisar las repercusiones de la prematuridad en la función visual
Extreme premature birth threatens visual function, not only because of Retinopathy of Prematurity's (ROP) potentially devastating effects on the eye, that can lead to blindness, not only because it can also be associated with myopia, strabismus and cerebral visual impairment. The increased survival of very low birth weight infants as neonatal care improves determines an increased incidence of these prematurity derived pathologies in infants. Nowadays, ROP is the leading cause of childhood blindness in median income countries like ours. Those premature infants that are not blinded by it can have its other sequelae with some degree of visual deficit. Childhood blindness, or even their visual limitation means many more years of disability than a cataract, glaucoma or a maculopathy that present late in life. For this reason, ocular pathologies associated with premature birth should be diagnosed and treated on time, and thus minimize their effect on the child and adult that he will eventually become. This article reviews repercussions of prematurity on visual function