Summers C G, Romig L, Lavoie J D
Department of Ophthalmology, University of Minnesota, Minneapolis 55455.
J Pediatr Ophthalmol Strabismus. 1991 May-Jun;28(3):134-6. doi: 10.3928/0191-3913-19910501-05.
Unilateral extensive myelination of the peripapillary nerve fibers may be associated with anisometropic myopia, strabismus, and reduced vision. Despite aggressive occlusion of the normal eye, visual results are often disappointing, presumably due to associated structural abnormalities in the macula which limit visual potential. We report two cases, a 21-month-old child and a 23-month-old child with unilateral peripapillary myelination, ipsilateral high myopia, and dense amblyopia. Despite an abnormal macular reflex in each child, vision improved to 20/30 in one child and 20/50 in the other child after occlusion therapy. Visual results in these patients suggest that aggressive amblyopia therapy should be considered in patients with anisometropic amblyopia associated with extensive myelination continuous with the optic nerve. Not all patients with unilateral peripapillary myelinated nerve fibers, an abnormal macula, and myopia will have refractory amblyopia.
视乳头周围神经纤维单侧广泛髓鞘化可能与屈光参差性近视、斜视及视力下降有关。尽管对正常眼进行了积极的遮盖治疗，但视觉效果往往令人失望，推测这是由于黄斑区存在相关结构异常，限制了视觉潜能。我们报告两例病例，一名21个月大的儿童和一名23个月大的儿童，均有单侧视乳头周围髓鞘化、同侧高度近视及重度弱视。尽管每个儿童的黄斑反射均异常，但在遮盖治疗后，其中一名儿童的视力提高到了20/30，另一名儿童的视力提高到了20/50。这些患者的视觉结果表明，对于伴有与视神经相连的广泛髓鞘化的屈光参差性弱视患者，应考虑积极的弱视治疗。并非所有单侧视乳头周围有髓鞘化神经纤维、黄斑异常及近视的患者都会有难治性弱视。
