CEREBRAL VISUAL IMPAIRMENT IN PERIVENTRICULAR LEUKOMALACIA

Infants with cerebral palsy (CP) frequently present cerebral visual im pairment (CVI) often caused by damage to retrochiasmatic pathways. Thi s is particularly true of subjects with damage to the periventricular white matter. Thirty-eight preterm infants with periventricular leukom alacia (PVL) diagnosed by MRI were examined to correlate binocular vis ual acuity with neuroradiological findings. Binocular visual acuity wa s evaluated using Teller Acuity Cards and a complete ophthalmological examination was also performed. Three infants with ROP III were exclud ed from the sample. The age of observation ranged from 20 months to 5 and a half years (mean 42 months). The possible involvement of the opt ic radiations and/or of the calcarine cortex was detected by brain MRI . Twenty-three infants (66%) presented visual impairment. Of these, 9 (26%) were totally or nearly totally blind and 14 (40%) were low visio n children. The other 12 (34%) had normal (2) or near normal (9) visio n. MRI findings correlated with visual acuity; a relationship was dete cted between the degree of visual acuity and the reduction of the peri trigonal white matter. and also between the degree of visual acuity an d the extent of calcarine atrophy. This report clearly establishes a r elationship between visual impairment and specific MRI findings in chi ldren with PVL. Teller Acuity Cards and MRI are useful for detecting p otential visual impairment and for improving both the clinical diagnos is of these disorders and the therapeutic approach to these subjects.