Huang Susan, Crawford J Brooks, Porco Travis, Rutar Tina
Department of Ophthalmology, Pediatric Ophthalmology and Strabismus, University of California-San Francisco, 10 Koret Way, San Francisco, CA 94143, USA.
J AAPOS. 2010 Aug;14(4):328-33. doi: 10.1016/j.jaapos.2010.05.006.
To evaluate diagnoses leading to enucleations in the pediatric age group over time.
All pathology reports of enucleation specimens at the University of California-San Francisco eye pathology laboratory from children (ages 0 to 18 years) from 1960 to 2008 were reviewed. The main outcome measures were the frequency of pediatric enucleation specimens in each diagnostic category as compared with total pathological laboratory volume over time, and the age and gender distribution of histopathological diagnostic categories over time.
Specimens of 746 eyes from 729 pediatric patients were analyzed. Pediatric enucleated eyes constituted 2.7% of all specimens received at the pathology laboratory. The overall frequency of pediatric enucleation specimens did not change over time. Retinoblastoma specimens increased by a factor of 2.9 over time (p < 0.0001). The increase in retinoblastoma was offset by a decrease in nonretinoblastoma enucleations, which decreased by a factor of 3.8 between the 1960s and 2000s (p < 0.0001), driven by a decrease in enucleations caused by trauma (p < 0.0001). Beginning in the 1980s, pediatric enucleations caused by nonrhegmatogenous retinal detachment, nematode and non-nematode endophthalmitis, and congenital glaucoma decreased significantly. Retinoblastoma was the most common diagnosis overall (45%), in girls (60%), and in ages <5 years (78%). Trauma was the second most common diagnosis (32%) and the most common in boys (42%) and in children ages 6-12 (58%) and 13-18 (72%) years.
A decrease in pediatric nonretinoblastoma enucleations was observed over time, possibly attributable to better diagnostic capabilities, surgical techniques, and public health interventions. The increase in retinoblastoma enucleations over time was likely due to the result of institutional referral bias.
评估不同时期导致儿童眼球摘除的诊断情况。
回顾了1960年至2008年加利福尼亚大学旧金山分校眼病理实验室接收的所有儿童（0至18岁）眼球摘除标本的病理报告。主要观察指标包括各诊断类别中儿童眼球摘除标本的频率随时间与病理实验室标本总量的比较，以及组织病理学诊断类别随时间的年龄和性别分布。
分析了729例儿童患者的746只眼标本。儿童眼球摘除标本占病理实验室接收的所有标本的2.7%。儿童眼球摘除标本的总体频率随时间未发生变化。视网膜母细胞瘤标本随时间增加了2.9倍（p<0.0001）。视网膜母细胞瘤的增加被非视网膜母细胞瘤眼球摘除的减少所抵消，非视网膜母细胞瘤眼球摘除在20世纪60年代至21世纪初减少了3.8倍（p<0.0001），这是由创伤导致的眼球摘除减少所驱动（p<0.0001）。从20世纪80年代开始，非孔源性视网膜脱离、线虫和非线虫性眼内炎以及先天性青光眼导致的儿童眼球摘除显著减少。视网膜母细胞瘤是总体上最常见的诊断（45%），在女孩中（60%）以及5岁以下儿童中（78%）最为常见。创伤是第二常见的诊断（32%），在男孩中（42%）以及6至12岁（58%）和13至18岁（72%）的儿童中最为常见。
随着时间的推移，观察到儿童非视网膜母细胞瘤眼球摘除减少，这可能归因于更好的诊断能力、手术技术和公共卫生干预措施。视网膜母细胞瘤眼球摘除随时间的增加可能是机构转诊偏倚的结果。
