Mudgil A V, Repka M X
Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287-9028, USA.
J AAPOS. 1999 Feb;3(1):2-8. doi: 10.1016/s1091-8531(99)70087-x.
The purpose of this study was to evaluate the causes and ophthalmologic outcome of oculomotor nerve palsy or paresis in children younger than 8 years of age.
Patients evaluated between 1985 and 1997 were retrospectively reviewed. Data analyzed included vision, residual strabismus after surgery, aberrant reinnervation, binocular function, and anisometropia. Long-term outcome was assessed in patients followed-up longer than 6 months.
Forty-one patients were identified. The most frequent causes were congenital (39%), traumatic (37%), and neoplastic (17%). Visual acuities were reduced in 71% of patients at the time of the initial visit. Long-term outcome could be assessed in 20 of the 41 patients (49%), with a mean follow-up of 3.6 years (range, 0.5 to 13 years). Visual acuities were reduced because of amblyopia in 35% and nonamblyopic factors in 25% of patients in the long-term outcome group at last follow-up. The best response to amblyopia therapy was in the congenital group, in which all patients improved to normal visual acuity. Strabismus surgery was performed on 8 of 20 children (40%) followed-up, none of whom demonstrated measurable stereopsis after operation despite improved alignment. Aberrant reinnervation was present in 9 of 20 patients (45%). Only 3 patients fully recovered from their oculomotor nerve injuries, and these were the only patients to regain measurable stereopsis. The causes in those 3 patients were congenital, traumatic, and neoplastic.
Oculomotor nerve palsy/paresis is associated with poor visual and sensorimotor outcome in children younger than 8 years of age. The best ophthalmologic outcome was in the resolved cases (3 of 20; 15%). Amblyopia therapy was most effective with congenital causes, but treatment results were poor with other causes. Young children with posttraumatic and postneoplastic oculomotor nerve injuries demonstrated the worst ophthalmologic outcomes.
本研究旨在评估8岁以下儿童动眼神经麻痹或不全麻痹的病因及眼科预后。
对1985年至1997年间评估的患者进行回顾性分析。分析的数据包括视力、手术后残余斜视、异常再支配、双眼视功能和屈光参差。对随访时间超过6个月的患者评估长期预后。
共确定41例患者。最常见的病因是先天性（39%）、创伤性（37%）和肿瘤性（17%）。初次就诊时71%的患者视力下降。41例患者中有20例（49%）可评估长期预后，平均随访3.6年（范围0.5至13年）。在长期预后组的患者中，最后随访时35%的患者因弱视导致视力下降，25%的患者因非弱视因素导致视力下降。弱视治疗效果最佳的是先天性组，该组所有患者视力均提高至正常。随访的20名儿童中有8名（40%）接受了斜视手术，尽管眼位改善，但术后无一例显示有可测量的立体视。20例患者中有9例（45%）存在异常再支配。只有3例患者从动眼神经损伤中完全恢复，这也是仅有的恢复可测量立体视的患者。这3例患者的病因分别是先天性、创伤性和肿瘤性。
8岁以下儿童动眼神经麻痹/不全麻痹与不良的视力和感觉运动预后相关。最佳眼科预后出现在病情缓解的病例中（20例中的3例；15%）。弱视治疗对先天性病因最有效，但对其他病因治疗效果不佳。创伤性和肿瘤性动眼神经损伤的幼儿眼科预后最差。
