Andersson Susann, Persson Eva-Karin, Aring Eva, Lindquist Barbro, Dutton Gordon N, Hellström Ann
Department of Ophthalmology, Institute of Clinical Neuroscience, The Sahlgrenska Academy of Göteborg University, Göteborg, Sweden.
Dev Med Child Neurol. 2006 Oct;48(10):836-41. doi: 10.1017/S0012162206001794.
Hydrocephalus in children has many aetiologies, and can cause multiple ophthalmic and visual disorders. This study sets out to detect and quantify visual and visuoperceptual dysfunction in children who have received surgical treatment for hydrocephalus with and without myelomeningocele, and to relate the results to the associated diagnoses and results from a comparison group. Seventy-five school-aged children (41 males, 34 females) with surgically-treated hydrocephalus and 140 comparison children (76 males, 64 females) matched for age and sex underwent comprehensive ophthalmologic examination. Median age at examination was 9 years and 4 months (range 7 y 4 mo-12 y 10 mo). Visual function deficits were identified in 83% (62/75) of the children with hydrocephalus. Visual impairment (binocular visual acuity <0.3) was found in 15% (11/73; comparison group 0%) but in none with myelomeningocele. Strabismus was found in 69% (51/74; comparison group 4% [5/140], p < 0.001), and refractive errors were found in 67% (47/70; comparison group 20% [28/140], p < 0.001). Cognitive visual dysfunction was identified in 59% (38/64; comparison group 3% [4/140], p < 0.001). These disorders were identified in various combinations and comprised impaired ability to plan movement through depth (e.g. going down a stair), impaired simultaneous perception, impaired perception of movement, impaired orientation, and (least frequently) impaired recognition. In this study, children with hydrocephalus associated with myelomeningocele were least commonly affected. Visual disorders were most frequent in those with epilepsy, cerebral palsy, and/or cognitive disability.
儿童脑积水有多种病因，可导致多种眼科和视觉障碍。本研究旨在检测和量化接受过或未接受过脊髓脊膜膨出手术治疗的脑积水患儿的视觉和视知觉功能障碍，并将结果与相关诊断以及对照组的结果进行关联分析。75名接受过脑积水手术治疗的学龄儿童（41名男性，34名女性）和140名年龄及性别匹配的对照儿童（76名男性，64名女性）接受了全面的眼科检查。检查时的中位年龄为9岁4个月（范围7岁4个月至12岁10个月）。83%（62/75）的脑积水患儿存在视觉功能缺陷。发现15%（11/73；对照组为0%）的患儿有视力损害（双眼视力<0.3），但脊髓脊膜膨出患儿中无一例出现。发现69%（51/74；对照组为4%[5/140]，p<0.001）的患儿有斜视，67%（47/70；对照组为20%[28/140]，p<0.001）的患儿有屈光不正。59%（38/64；对照组为3%[4/140]，p<0.001）的患儿存在认知性视觉功能障碍。这些障碍以各种组合形式出现，包括通过深度规划运动的能力受损（如下楼梯）、同时感知受损、运动感知受损、定向受损以及（最不常见的）识别受损。在本研究中，合并脊髓脊膜膨出的脑积水患儿受影响最少。视觉障碍在患有癫痫、脑瘫和/或认知障碍的患儿中最为常见。
