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  • Pediatric Ophth/Strabismus

    Review of: Prevalence of the infantile strabismus complex in premature children with and without periventicular leukomalacia

    Khanna S, Sharma A, Ghasia F, et al. American Journal of Ophthalmology, August 2022

    Investigators evaluated the association between the presence and severity of periventular leukomalacia (PVL) and infantile strabismus complex in infants born prematurely.

    Study design

    This was a retrospective, case-control study at a single US-based urban children's hospital in which the relationship between PVL and strabismus was quantified in 98 premature children via 2 specific evaluations: magnetic resonance imaging (MRI) of the brain and ocular motor examination. The researchers evaluated whether there were different rates of strabismus and other visuomotor deficits among premature children with different levels of PVL severity, and if premature children with and without evidence of PVL on MRI brain scans had different rates of strabismus.


    Strabismus was approximately 4 times more likely in premature children with PVL than in children without PVL (77% and 16%, respectively). Compared with strabismus rates reported in full-term children, rates were much higher in this patient population: 17 times higher in the PVL cohort and 4 times higher in the non-PVL cohort. Significant differences between those with PVL and those without PVL were noted for most ocular motor exam components.


    Unlike other studies, this study reported the severity of PVL and its relationship to infantile strabismus complex with the grading/scoring system in both the 67 premature children with PVL and the 31 children without PVL. However, there were no subgroupings based on age. Another limitation of this study was that all MRI evaluations were performed at a single MRI brain center.

    Clinical significance

    This study shows the strong clinical relationship between severity of PVL in premature children with infantile strabismus complex and, in turn, how the perinatal damage to cerebral vergence and gaze pathways can be documented and quantified by neuroimaging and ocular motor exam. Future clinical studies that involve multiple imaging centers would be important to further evaluate the strong correlation between strabismus and prematurity with the diagnosis of PVL by neuroimaging in a larger cohort. In addition, the study results show the importance of a multidisciplinary relationship among radiology, pediatric ophthalmology, and neuro-ophthalmology regarding the evaluation and management of infantile strabismus complex for premature infants with and without PVL.