Gogate Parikshit, Gilbert Clare, Zin Andrea
Dr. Gogate's Eye Clinic, Pune, India.
Middle East Afr J Ophthalmol. 2011 Apr;18(2):109-14. doi: 10.4103/0974-9233.80698.
Childhood blindness has an adverse effect on growth, development, social, and economic opportunities. Severe visual impairment (SVI) and blindness in infants must be detected as early as possible to initiate immediate treatment to prevent deep amblyopia. Although difficult, measurement of visual acuity of an infant is possible. The causes of SVI and blindness may be prenatal, perinatal, and postnatal. Congenital anomalies such as anophthalmos, microphthalmos, coloboma, congenital cataract, infantile glaucoma, and neuro-ophthalmic lesions are causes of impairment present at birth. Ophthalmia neonatorum, retinopathy of prematurity, and cortical visual impairment are acquired during the perinatal period. Leukocoria or white pupillary reflex can be cause by congenital cataract, persistent hyperplastic primary vitreous, or retinoblastoma. While few medical or surgical options are available for congenital anomalies or neuro-ophthalmic disorders, many affected infants can still benefit from low vision aids and rehabilitation. Ideally, surgery for congenital cataracts should occur within the first 4 months of life. Anterior vitrectomy and primary posterior capsulotomy are required, followed by aphakic glasses with secondary intraocular lens implantation at a later date. The treatment of infantile glaucoma is surgery followed by anti-glaucoma medication. Retinopathy of prematurity is a proliferation of the retinal vasculature in response to relative hypoxia in a premature infant. Screening in the first few weeks of life can prevent blindness. Retinoblastoma can be debulked with chemotherapy; however, enucleation may still be required. Neonatologists, pediatricians, traditional birth attendants, nurses, and ophthalmologists should be sensitive to a parent's complaints of poor vision in an infant and ensure adequate follow-up to determine the cause. If required, evaluation under anesthesia should be performed, which includes funduscopy, refraction, corneal diameter measurement, and measurement of intraocular pressure.
儿童失明会对生长、发育、社交及经济机会产生不利影响。必须尽早发现婴儿的严重视力损害（SVI）和失明情况，以便立即开始治疗，预防严重弱视。尽管困难，但测量婴儿的视力是可行的。SVI和失明的原因可能是产前、围产期和产后的。先天性异常，如无眼、小眼、缺损、先天性白内障、婴儿型青光眼和神经眼科病变是出生时就存在的视力损害原因。新生儿眼炎、早产儿视网膜病变和皮质视力损害是在围产期获得的。白瞳症或白色瞳孔反射可能由先天性白内障、永存原始玻璃体增生或视网膜母细胞瘤引起。虽然对于先天性异常或神经眼科疾病几乎没有医学或手术选择，但许多受影响的婴儿仍可从低视力辅助器具和康复中受益。理想情况下，先天性白内障手术应在出生后的头4个月内进行。需要进行前部玻璃体切除术和原发性后囊切开术，随后佩戴无晶状体眼镜，并在稍后植入人工晶状体。婴儿型青光眼的治疗是手术，然后使用抗青光眼药物。早产儿视网膜病变是早产儿视网膜血管因相对缺氧而增生。在出生后的头几周进行筛查可以预防失明。视网膜母细胞瘤可以通过化疗缩小肿瘤体积；然而，可能仍需要进行眼球摘除术。新生儿科医生、儿科医生、传统助产士、护士和眼科医生应重视家长对婴儿视力不佳的投诉，并确保进行充分的随访以确定病因。如有需要，应在麻醉下进行评估，包括眼底检查、验光、角膜直径测量和眼压测量。
