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150 Timing of optic nerve changes following ventriculoperitoneal shunt in paediatric patients

Abstract

Paediatric ophthalmology departments are under pressure for appointments and receive numerous referrals including neurosurgical patients who have been treated for raised intracranial pressure. Our aim is to describe the timing of optic nerve head (ONH) changes in particular the retinal nerve fibre layer (RNFL) using optical coherence tomography (OCT) following ventriculoperitoneal (VP) shunt in paediatric patients.

A retrospective case note review was carried out on paediatric patients who had VP shunt insertion and had attended the ophthalmology department of a large tertiary paediatric hospital with regional neurosurgery centre from December 2018 - December 2021.

Seven patients were included (14 eyes) with follow-up ranging from 1 to 12 months (median = 12 months). Underlying diagnoses included idiopathic intracranial hypertension, neoplasm, aqueductal stenosis and Arnold Chiari malformation. Opening cerebrospinal fluid pressure ranged from 31-60cmH2O. Following VP shunt RNFL height fell from a mean of 239.2 µm (range = 108.4-321.75µm) to 135.9 µm (range = 37.5 – 119.4µm). This decrease was visible in the first week to one month. 5 patients had normal visual and colour acuity at baseline; 1 patient had reduced acuity which improved post shunt and the remaining patient had reduced colour vision which persisted.

There is a paucity of data on this topic and our results agree with the singular published article researching ONH changes following VP shunt.

This study informs paediatric ophthalmologists that ONH changes occur shortly following VP shunt insertion with possible reversal of visual symptoms if present. This helps both ophthalmology and neurosurgical departments coordinate timely reviews.

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