儿童视神经炎

Optic neuritis in children.

作者信息

Morales D S, Siatkowski R M, Howard C W, Warman R

机构信息

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Fla, USA.

出版信息

J Pediatr Ophthalmol Strabismus. 2000 Sep-Oct;37(5):254-9.

PMID:11020105

Abstract

PURPOSE

To describe the clinical characteristics of optic neuritis in children, including final visual acuity and development of multiple sclerosis (MS).

METHODS

Charts were reviewed of all patients < 15 years of age who presented with optic neuritis to the Bascom Palmer Eye Institute or the Miami Children's Hospital between 1986 and 1998.

RESULTS

Fifteen patients were identified. There was a slight female predilection in the study group (60%), with a mean age of 9.8 years at presentation. A preceding febrile illness within 2 weeks of visual symptoms was reported in 66% of patients. Initial visual acuity ranged from 20/15 to no light perception. Involvement was bilateral in 66% of patients, and disc swelling was present in 64% of involved eyes. Of the patients who underwent magnetic resonance imaging, 33% had focal demyelinating lesions in the brain, and 63% of affected nerves were enlarged or enhanced with gadolinium. Eleven patients were treated with intravenous steroids. Final visual acuity was > or = 20/40 in 58.3% of eyes. Thirty percent of the patients had vision of finger counting or worse. Four (26%) patients developed MS. The mean age of patients with MS was 12 years, compared with 9 years in children who did not develop MS. Patients with unilateral involvement had an excellent visual prognosis (100% > 20/40), but a higher rate of development of MS (75%). Two patients had positive serology for Lyme disease.

CONCLUSIONS

Optic neuritis presents differently in children than in adults. Children typically have bilateral involvement with papillitis following an antecedent viral illness. Although visual prognosis is poorer in children than adults, the development of MS is less common in children. Children who present with unilateral involvement have a better visual prognosis; however, they also develop MS at a greater frequency than children with bilateral involvement. Patients who developed MS were, on average, older at presentation with optic neuritis than those who did not develop MS.

摘要

目的

描述儿童视神经炎的临床特征，包括最终视力及多发性硬化症（MS）的发展情况。

方法

回顾了1986年至1998年间在巴斯科姆·帕尔默眼科研究所或迈阿密儿童医院就诊的所有15岁以下视神经炎患者的病历。

结果

共确定了15例患者。研究组中女性略占优势（60%），就诊时平均年龄为9.8岁。66%的患者在视觉症状出现前2周内有发热性疾病史。初始视力范围从20/15至无光感。66%的患者为双侧受累，64%的受累眼出现视盘肿胀。在接受磁共振成像检查的患者中，33%的患者脑部有局灶性脱髓鞘病变，63%的受累神经增粗或在注射钆后有强化表现。11例患者接受了静脉注射类固醇治疗。58.3%的患眼最终视力≥20/40。30%的患者视力为指测或更差。4例（26%）患者发展为MS。患MS的患者平均年龄为12岁，未患MS的儿童平均年龄为9岁。单侧受累的患者视觉预后良好（100%＞20/40），但MS发生率较高（75%）。2例患者莱姆病血清学检查呈阳性。