OPHTHALMOLOGIC EXAMINATION AND STUDY OF VISUAL CONSEQUENCES IN CHILDREN WITH PRIMARY BRAIN TUMORS
K.B. Yrysov, B.A. Beknazarova, Alik kyzy E., N.A. Mamaziyaeva
Purpose of the work: To study the visual consequences of children with primary brain tumors who were sent for ophthalmological examination without a standard protocol.
Material and Methods: Medical records of all children (0-18 years old) with primary brain tumors were analyzed. In our institution, all children referred for ophthalmological examination were examined by pediatricians and / or neuro-ophthalmologists. For each patient, the following clinical data were collected: age at the time of tumor diagnosis, gender, pathologic diagnosis, major problems at initial presentation (including visual problems), tumor location, classification of surgical resection, treatment methods, and survival.
Humphrey visual field testing, optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL), and fundus color photographs were obtained from collaborating patients.
Results. A total of 141 patients (73 [52%] men; mean age [range 0-18] years) with primary brain tumors were included. There were 100 people who were recently diagnosed and 41 people who were examined for follow-up examination (brain tumor was diagnosed before enrollment in the study). The most common type of tumor was glioma, while other types of tumors (eg, ependymoma and atypical teratoid rhabdoid tumors) were less common. There were more patients with tumors of the parenchyma and fewer with tumors of the optic nerve and chiasm.
A decrease in visual acuity was observed in 37 patients (54%) in 1 or both eyes, of which 26 out of 68 (38%) had progressed amblyopia. Causes included deprivation (ptosis, keratopathy, and / or cataract) in 15 patients (58%), strabismus in 11 patients (42%), and refractive errors in 11 patients (42%). Exposure keratopathy due to palsy of the seventh cranial nerve was found in 10 patients (15%), of which 3 (30%) required aggressive treatment (tarsorrhaphy or corneal transplant).
Conclusion. The time has come for an interdisciplinary, integrated approach to the diagnosis and treatment of visual impairment in children with brain tumors. Given the significant advances in technology, OCT analysis of the retinal nerve fiber layer and ganglion cell complex in children under 3 years of age usually complements a thorough pediatric and / or neuro-ophthalmic assessment.
Key words : primary brain tumors, ophthalmological examination, decreased visual acuity, visual fields.