Perinatal cortical and subcortical visual loss: mechanisms of injury and associated ophthalmologic signs.
OBJECTIVE
To determine whether term and preterm injuries to the retrogeniculate visual system are associated with recognizable patterns of ophthalmologic abnormalities and whether these patterns can be attributed to cortical (gray matter) or subcortical (white matter) injury.


METHODS
A retrospective case series.


METHODS
One hundred children with clinical and neuroimaging signs of perinatal posterior visual pathway injury who were examined at Arkansas Children's Hospital Eye Clinic between 1989 and 1999.


METHODS
We reviewed magnetic resonance images or computed tomographic scans from 50 children with cortical (predominantly or exclusively involving cortical gray matter) and 50 children with subcortical (predominantly or exclusively involving subcortical white matter) perinatal injury to the retrogeniculate visual system. Ophthalmologic abnormalities were analyzed retrospectively in each group.


METHODS
Conjugate gaze deviation, type of strabismus, abnormal eye movements, and optic disc morphology.


RESULTS
Horizontal conjugate gaze deviation, exotropia, and a normal optic disc appearance were significantly more common in cortical than in subcortical visual loss. Tonic downgaze, esotropia, and optic nerve hypoplasia (with or without coexisting pallor) were significantly more common in subcortical than in cortical visual loss.


CONCLUSIONS
Perinatal cortical and subcortical visual loss produce differing profiles of ophthalmologic dysfunction. A reclassification of periventricular leukomalacia and other forms of retrogeniculate white matter injury as subcortical visual loss would increase diagnostic specificity.
Brodsky
Michael C
MC
Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA.
Fray
Katherine J
KJ
Glasier
Charles M
CM
D019575:Blindness, Cortical / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008279:Magnetic Resonance Imaging; D015835:Ocular Motility Disorders / Q000175:diagnosis* / Q000209:etiology; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies; D013285:Strabismus / Q000175:diagnosis* / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity; D014793:Visual Cortex / Q000293:injuries* / Q000473:pathology; D014795:Visual Pathways / Q000293:injuries* / Q000473:pathology