Macintosh Claire, Wells Rachel, Johnson David, Wall Steve
Oxford Craniofacial Unit, John Radcliffe Hospital, Oxford, UK.
J Craniofac Surg. 2011 Jul;22(4):1280-3. doi: 10.1097/SCS.0b013e31821c6a64.
Metopic synostosis is a premature fusion of the metopic cranial suture. Small case studies into the effects on vision have suggested that there is a raised incidence of astigmatic refractive error with increased risk of failure to develop normal vision if reconstructive surgery is delayed beyond 7 months of age. The aim of this study was to look at a much larger group of patients to give more statistical significance on the incidence of significant refractive error and strabismus in cases of metopic synostosis and compare this with that known for the general population of children at a similar age. A secondary objective was to look at the age at surgery and the visual outcome. A retrospective analysis of case notes was carried out for 64 children with a confirmed diagnosis of metopic synostosis attending the Oxford Craniofacial Unit. Twenty children (31%) were found to have a visual problem, with 18 needing glasses to correct a refractive error and 10 having strabismus. The nature of refractive error was generally hypermetropia, in some cases combined with low astigmatism (1.5 diopters [D] or less). Only 1 child was recorded as having more than 1.5 D of astigmatism. The age at surgery did not seem to influence visual outcome. The incidence of significant refractive error requiring correction and strabismus across the metopic group (31%) was higher than that found in the general population of children at a similar age (5%-11%). This reinforces the importance of orthoptic/ophthalmic surveillance in metopic synostosis.
额缝早闭是额颅缝的过早融合。针对其对视力影响的小型病例研究表明，散光性屈光不正的发生率有所上升，如果重建手术推迟到7个月龄之后，出现正常视力发育不良的风险会增加。本研究的目的是观察规模大得多的患者群体，以便更有统计学意义地了解额缝早闭病例中显著屈光不正和斜视的发生率，并将其与同龄儿童总体人群的已知情况进行比较。第二个目标是研究手术年龄和视力结果。对在牛津颅面科就诊的64例确诊为额缝早闭的儿童的病历进行了回顾性分析。发现20名儿童（31%）存在视力问题，其中18名需要配镜矫正屈光不正，10名患有斜视。屈光不正的性质一般为远视，在某些情况下合并低度散光（1.5屈光度[D]或更低）。只有1名儿童记录的散光超过1.5 D。手术年龄似乎不影响视力结果。额缝早闭组中需要矫正的显著屈光不正和斜视的发生率（31%）高于同龄儿童总体人群中的发生率（5%-11%）。这强化了在额缝早闭中进行斜视/眼科监测的重要性。
