Lj. Balcer et al., Visual loss in children with neurofibromatosis type 1 and optic pathway gliomas: Relation to tumor location by magnetic resonance imaging, AM J OPHTH, 131(4), 2001, pp. 442-445
PURPOSE: To examine the potential for visual acuity loss, and its relation
to extent and location of optic pathway gliomas in a cohort of children wit
h neurofibromatosis type I studied with magnetic resonance imaging.
METHODS: We reviewed the neuro-ophthalmologic records and brain/orbital mag
netic resonance imaging scans for 43 consecutive pediatric patients with ne
urofibromatosis type I and optic pathway gliomas who were followed at the C
hildren's Hospital of Philadelphia. The presence of visual loss, defined as
abnormal visual acuity for age in one or both eyes, was determined. Optic
pathway gliomas were classified by tumor extent and location according to i
nvolvement of the optic nerves, chiasm, and postchiasmal structures by magn
etic resonance imaging.
RESULTS: involvement of the optic tracts and other postchiasmal structures
at tumor diagnosis was associated with a significantly higher probability o
f visual acuity loss (P = .048, chi-square test). Visual loss was noted in
20 of 43 patients (47%) at a median age of 4 years; however, three patients
developed visual acuity loss for the first time during adolescence.
CONCLUSIONS: In pediatric patients with neurofibromatosis type 1 and optic
pathway gliomas, the likelihood of visual loss is dependent on the extent a
nd location of the tumor by magnetic resonance imaging and is particularly
associated with involvement of postchiasmal structures. Furthermore, older
age during childhood (adolescence) does not preclude the occurrence of visu
al loss. Close follow-up beyond the early childhood years, particularly for
those with postchiasmal tumor, is recommended. (Am J Ophthalmol 2001;131:4
42-445. (C) 2001 by Elsevier Science inc. All rights reserved).