伴有中枢性疾病的婴幼儿斜视临床特征  

Clinical feature analysis of pediatric strabismus patients with neurologic diseases

作　　者：许宇[1] 亢晓丽[1] 陈奕烨[1] 韦严[1] 岑洁[1] 董凌燕[1] 

机构地区：[1]上海交通大学医学院附属新华医院眼科,200092

出　　处：《中华眼视光学与视觉科学杂志》2013年第9期533-536,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：上海市市级医院新兴前沿技术联合攻关项目（SHDC12010107）

摘　　要：目的分析总结伴有中枢性疾病的婴幼儿斜视患者的一般临床特征和斜视类型。方法回顾性系列病例研究。收集2010年1月至2011年3月就诊于上海交通大学医学院附属新华医院的患有中枢性疾病合并斜视患儿（23例）的临床资料，其中男12例（52％），女11例（48％）。对患儿发病年龄、就诊时年龄、斜视类型、屈光状态、眼底及视力等情况进行描述性分析。结果所有患儿均在生后6个月内发现斜视，患儿就诊时的年龄为6个月至8岁，平均（3．8±2．1）岁。外斜视18例（78％），水平外斜视的度数为-30-—．120，平均（-73．6±30．6）。内斜视5例（22％），其中部分调节性内斜视1例，非调节性内斜视4例；水平内斜视度数为＋25A-＋35“，平均（＋29．0±4．2）0。合并A型斜视5例，合并V型斜视4例，合并DVD4例，合并隐性眼球震颤l例。能够进行视力检查的7例患儿，无一例最佳矫正视力在0．8以上。术前能够配合同视机检查的12例患儿中无一例有同时视。患儿中脑瘫15例（65％），脑积水3例（13％），脑发育迟缓3例（13％），癫痫1例（4％）．缺血缺氧性脑病1例（4％）。共有22例患儿行手术治疗，手术量的设计按照常规手术量计算．其中11例患儿（占50％）手术涉及3条直肌，且均为外斜视。随访3～15个月，平均（9．6±3．6）个月。术后正位20例；能够配合同视机检查12例患儿中，7例无同时视，3例有同时视，2例有融合视。结论伴有中枢性疾病的婴幼儿斜视表现为共同性的先天性斜视，且以大角度的外斜视居多；中枢性疾病中以脑瘫居多。多数患儿伴有一定程度的弱视以及双眼视功能的破坏。Objective To analyze and summarize the clinical features and types of strabismus in pediatric patients with neurologic diseases. Methods The clinical data of pediatric patients with neurologic diseases who visited the Ophthalmology Department of Xinhua Hospital from January 2010 to March 2011 were retrospectively analyzed. The data included sex, age, type of strabismus, refractive errors, ocular fundus and visual acuity. Twenty-three patients were diagnosed as strabismic children with neurologic disease. Among them, twelve were males （52%） and eleven were females （48%）. Results They were diagnosed at an average age of 3.8±2.1 years （range from 6 months to 8 years）. Eighteen patients （78%） had exotropia with a horizontal strabismic angle ranging from -30--120 PD （mean -73.6±30.6 PD）; 5 cases （22%） had esotropia, 1 had primarily accommodative esotropia and 4 had nonaecommodative esotropia with a horizontal esotropia strabismic angle ranging from ＋25-＋35 PD （mean ＋29.0±4.2 PD）. Five patients had an A-pattern and 4 patients had a V-pattern; 4 patients had DVD and 1 had latent nystagmus. Visual acuity measurements were possible in only 7 patients and their best corrected visual aeuities were all below 0.8. No one had stereoscopic vision before the surgery. Fifteen patients （65%） had associated cerebral palsy, 3（13%） had hydrocephalus, 3（13%） had mental retardation, 1（4%） had epilepsy and 1 patient （4%） had associated hypoxic ischemia encephalopathy. Twenty-two patients agreed to have strabismus surgery. The median follow-up was 9.6±3.6 months （range from 3 to 15 months）. Twenty patients （91%） returned to a normal primary eye position and 5 patients recovered different degrees of binocular vision. Conclusion Strabismus of congenital exotropia was found to be common in patients with neurologic diseases. Cerebral palsy was the most common neurologie disease. Amblyopia or destruction of binocular vision was found in the great majority of the cases.

关 键 词：斜视 中枢异常 婴儿 儿童 

分 类 号：R779.6[医药卫生—眼科]