The prevalence of strabismus and visual outcomes in children with hydrocephalus and a ventriculoperitoneal shunt: medical record review.

BACKGROUND

Many ophthalmological complications have been associated with hydrocephalus (HC), including ocular motility disorders, visual field defects, optic atrophy, and loss of visual acuity. No studies have investigated the prevalence of strabismus and visual outcomes of children with congenital HC after ventriculoperitoneal (VP) shunt in Saudi Arabia.

OBJECTIVES

Estimate the frequency of strabismic children diagnosed with HC who underwent a VP shunt procedure.

DESIGN

Medical record review

SETTING

Tertiary care center PATIENTS AND

METHODS

We reviewed the files of all pediatric patients diagnosed with hydrocephalus before the age of 2 years and treated with shunts during the period 2010 to 2020 at our institution.

MAIN OUTCOME MEASURES: Strabismus types and ophthalmic assessment (visual state, outcomes, and ocular motility state).

SAMPLE SIZE AND CHARACTERISTICS: 190 children; 98 (51.5%) males.

RESULTS

Eighty-nine (46.8%) had congenital HC followed by intraventricular hemorrhage 36 (18.9%); 74 (38.9%) patients had regular follow-ups in ophthalmology. Sixty-five (34.2%) patients had no ophthalmic assessment or fundus examination records, while 63 (33.1%) were diagnosed with strabismus. At the initial assessment, 26 (13.6%) patients had exotropia (XT). At the final assessment, 7 (3.6%) patients had XT. The association between VP shunt and strabismus was statistically significant, (χ2=6.534, df=1, P<.01).

CONCLUSION

More than one-third of children diagnosed with HC who had surgical treatment in a tertiary hospital did not have any records of ophthalmic assessment, which highlights the need to implement a specific ophthalmological examination protocol in patients with HC. Further studies are needed to analyze the association between VP shunt and strabismus.

LIMITATIONS: Evaluating the ocular state and visual function before and after VP shunt was not possible.

CONFLICT OF INTEREST: None.