Department of Pediatrics, University of Padua, Padua, Italy.
J Neuroophthalmol. 2010 Mar;30(1):26-30. doi: 10.1097/WNO.0b013e3181c252b9.
Few studies provide follow-up information or systematic investigation of prognostic parameters of nonorganic (psychogenic) visual loss in children.
A retrospective case series analysis was performed on 58 patients younger than 16 years old who had nonorganic visual loss and underwent at least a 3-month follow-up clinic visit and/or telephone interview between 1992 and 2007 at a single institution in Italy. All patients underwent a full neurologic, ophthalmologic, and orthoptic evaluation. Visual electrophysiologic tests were performed in many patients as part of the evaluation. Neuroimaging was performed and psychiatric referral was made only as needed. We collected data on the age at onset, time to diagnosis of nonorganic visual loss, type and duration of visual symptoms, and concomitant psychologic or psychosocial difficulties.
Visual deficits consisted mostly of reduced visual acuity (76%) and visual field defects (48%). The diagnosis of nonorganic visual loss could be reached with confidence by means of observing inconsistent performance on a wide array of visual function tests, and, in doubtful cases, by means of electrophysiologic investigations. The mean time from onset to diagnosis was 3.1 months. The mean duration of visual symptoms from reported onset to disappearance was 7.4 months. Complete resolution of all visual symptoms occurred in 93% of patients and did so within 12 months of diagnosis in 85% of patients. There was no correlation between the duration of visual symptoms and age at onset, sex, time to diagnosis, type of ocular symptoms, or presence of psychosocial or psychologic difficulties.
Our study extends the follow-up information and confirms the findings of previous investigators in showing that nonorganic visual loss in children generally resolves spontaneously within 1 year and that no major psychiatric disorders are present or will appear after diagnosis. However, psychosocial stressors are often present and may predispose to this manifestation. There are no obvious predictors of rate of recovery.
很少有研究提供非器质性（心因性）儿童视觉丧失的预后参数的随访信息或系统调查。
对 1992 年至 2007 年期间在意大利的一家单机构就诊且至少接受过 3 个月随访门诊和/或电话访谈的 58 例年龄小于 16 岁的非器质性视觉丧失患者进行回顾性病例系列分析。所有患者均接受了全面的神经科、眼科和斜视评估。许多患者接受了视觉电生理检查作为评估的一部分。仅在需要时进行神经影像学检查和精神科转诊。我们收集了发病年龄、非器质性视觉丧失诊断时间、视觉症状的类型和持续时间以及同时存在的心理或心理社会困难的数据。
视觉缺陷主要包括视力下降（76%）和视野缺损（48%）。通过观察各种视觉功能测试的不一致表现，可以有把握地诊断非器质性视觉丧失，在可疑病例中，可以通过电生理检查来诊断。从发病到诊断的平均时间为 3.1 个月。从报告发病到症状消失的平均视觉症状持续时间为 7.4 个月。93%的患者所有视觉症状完全缓解，85%的患者在诊断后 12 个月内完全缓解。视觉症状持续时间与发病年龄、性别、诊断时间、眼部症状类型或是否存在心理社会或心理困难之间无相关性。
我们的研究扩展了随访信息，并证实了先前研究人员的发现，即儿童非器质性视觉丧失通常在 1 年内自发缓解，并且在诊断后不会出现或出现重大精神障碍。然而，心理社会应激因素常常存在，并可能导致这种表现。恢复速度没有明显的预测因素。
