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Visual Function Twenty Years After Childhood Hemispherectomy for Intractable Epilepsy

Handley, SE; Vargha-Khadem, F; Bowman, RJ; Liasis, A; (2017) Visual Function Twenty Years After Childhood Hemispherectomy for Intractable Epilepsy. American Journal of Ophthalmology , 177 pp. 81-89. 10.1016/j.ajo.2017.02.014. Green open access

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Abstract

PURPOSE: To investigate visual function in adults post hemispherectomy in childhood. DESIGN: Non-comparative case series. METHODS: All participants underwent visual acuity, binocular function, visual field, optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL), and monocular pattern reversal visually evoked potentials (prVEP). PARTICIPANTS: 6 adults who had a hemispherectomy in childhood (median 21.5 years post-op). MAIN OUTCOME MEASURES: Comparison was made of visual acuity, visual field height, global RNFL thickness and prVEP amplitude evoked by full and half field stimulation. Comparison of the eye ipsilateral to the side of surgery to the contralateral eye was achieved employing paired t-tests to the visual function measures. RESULTS: All participants had homonymous hemianopia. The residual seeing visual field was constricted in all cases when compared to normative data despite crossing the midline into the blind hemi field in 11/12 eyes. This observation was supported by prVEP's to stimuli presented in the blind half field. The height of visual field was smaller in the eye contralateral to side of surgery compared to the ipsilateral side (P=0.047). Visual acuity and RNFL thickness also showed greater diminution in the eye contralateral (P=0.040 and P=0.0004). Divergent strabismus was in four participants with greater field loss. CONCLUSIONS: Adults post hemispherectomy in childhood may have better visual function in the eye ipsilateral to the side of the hemispherectomy compared to the contralateral eye. Possible mechanisms of the inter-ocular difference are discussed. Though visual fields and prVEP responses demonstrate evidence of re-organization in to the blind half field, they also reveal significant un-expected constriction of the functional field.

Type: Article
Title: Visual Function Twenty Years After Childhood Hemispherectomy for Intractable Epilepsy
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ajo.2017.02.014
Publisher version: http://dx.doi.org/10.1016/j.ajo.2017.02.014
Language: English
Additional information: This manuscript version is published under a Creative Commons Attribution Non-commercial Non-derivative 4.0 International licence (CC BY-NC-ND 4.0). This licence allows you to share, copy, distribute and transmit the work for personal and non-commercial use providing author and publisher attribution is clearly stated. Further details about CC BY licences are available at http://creativecommons.org/licenses/by/4.0. Access may be initially restricted by the publisher.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health > ICH Developmental Neurosciences Prog
URI: http://discovery.ucl.ac.uk/id/eprint/1543940
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