Optic disc morphology may reveal timing of insult in children with periventricular leucomalacia and/or periventricular haemorrhage

Abstract

Aims: To evaluate the relation between optic disc morphology and timing of periventricular white matter damage, defined as either periventricular leucomalacia (PVL) or periventricular haemorrhage (PVH), as estimated by neuroradiology.

Methods: 35 children with periventricular white matter damage who had had neuroradiology performed and ocular fundus photographs taken had their photographs analysed by digital image analysis and compared with a control group of 100 healthy full term children. Timing of brain lesion was estimated by analysis of the brain lesion pattern on neuroradiological examinations (magnetic resonance imaging or computed tomography).

Results: Four of 35 children had a small optic disc area; these four children had a brain lesion estimated to have occurred before 28 weeks of gestation. Nine of 11 children with a large cup area had a PVL/PVH estimated to have occurred after 28 weeks of gestation. The children with PVL/PVH had a significantly larger cup area (median 0.75 mm(2)) than the control group (median 0.33 mm(2)) (p = 0.001) and a significantly smaller neuroretinal rim area (median 1.58 mm(2)) than the controls (median 2.07 mm(2)) (p = 0.001).

Conclusion: In a child with PVL/PVH and abnormal optic disc morphology, the possibilities of timing of the lesion should be considered.

Figures

Figure 1

(A) Fundus photograph and CT of a 5 year old girl with gestational age at birth of 34 weeks, esotropia, and visual acuity 20/100. The optic disc has a small area. The CT scan shows extensive loss of periventricular white matter including almost all white matter in the right cerebral hemisphere. This image represents the end stage following a periventricular haemorrhagic infarction, indicating an early lesion. (B) Fundus photograph and MRI of a 10 year old boy with gestational age 31 weeks at birth and perinatal asphyxia. He is ortophoric, with visual acuity right eye 20/20, 20/30 left eye, and small bilateral defects in the inferior fields, normal intraocular pressure. The optic disc has a large cup in a normal sized optic disc. The T2 weighted MR scan demonstrates focal dilatation of the occipital horns, more pronounced in the right cerebral hemisphere, reflecting loss of peritrigonal white matter. White matter is preserved anteriorly as well as in centrum semiovale (not shown), indicating a late lesion.

Figure 2

Individual optic disc variables depicted as open circles, in relation to timing of brain lesion as estimated by neuroimaging, before 28 gestational weeks (GW) or equal to and after 28 weeks of gestation. The 95th reference interval for healthy children is depicted as a shaded area.

Figure 3

Schematic illustration of number of children and their optic disc morphology in relation to estimated timing of brain lesion. *Below the 2.5th centile of the reference group. †Above the 97.5th centile of the reference group.