Ophthalmic Outcomes in Children With Spina Bifida Myelomeningocele in Ireland.

Abstract

Purpose: To investigate the ophthalmic complications associated with spina bifida myelomeningocele (SBM) in Irish children and to evaluate the impact of spinal lesion levels and shunt status on visual outcomes.

Methods: A retrospective audit was conducted on 129 children with SBM, examining visual acuity, refractive errors, strabismus, papilledema, optic atrophy, and cortical visual impairment (CVI). The median age of participants was 6.9 years (interquartile range [IQR] = 7.07), comprising 69 females (53.5%) and 60 males (46.5%). Data were analyzed using chi-square and Kruskal-Wallis tests to assess associations between spinal lesion levels, shunt status, and visual outcomes.

Results: The majority of lesions were lumbar (60.47%), followed by sacral (20.16%), thoracic (18.60%), and occipital (0.78%). Ventriculoperitoneal shunts were present in 67.44% of participants. Most children had good visual acuity, with visual impairment observed in 18.2%. Significant refractive errors were present in 40.8% of cases, whereas strabismus was observed in 33.3% of patients, predominantly esotropia. Papilledema, optic atrophy, and CVI were present in 12.4%, 5.4%, and 4.7% of participants. Higher spinal lesion levels were significantly associated with worse visual acuity (P = .019), whereas ventriculoperitoneal shunt status was significantly associated with papilledema (P = .034) and significant refractive errors (P = .019). No significant associations were found for strabismus, optic atrophy, or CVI.

Conclusions: Ophthalmic complications such as refractive errors, strabismus, and visual impairment are common in children with SBM. The authors found that higher spinal lesions were associated with worse visual acuity. Shunt placement was also associated with a history of papilledema and higher rates of significant refractive error. [J Pediatr Ophthalmol Strabismus. 20XX;XX(X):XXX-XXX.].