Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel Petach Tikva, Israel.
Front Neurol. 2011 Sep 30;2:62. doi: 10.3389/fneur.2011.00062. eCollection 2011.
The purpose of this study was to characterize the severe postoperative irreversible visual loss induced by optic neuropathy in some children with a brain tumor. The computerized database (2003-2008) of a neuro-ophthalmology service of a major pediatric tertiary center was reviewed for all children with severe irreversible visual loss (counting fingers or less) due to brain-tumor-related optic neuropathy at their last follow-up examination. Data on age, gender, etiology, initial symptoms, and signs, visual acuity before and after surgery and at last examination, neuroimaging findings, and treatment were collected. Of 240 children, 198 were operated. Of those, 10 (5%, 5 boys and 5 girls) met the study criteria. Data for the initial visual examination were available for eight children: one had binocular blindness (uncertain light perception, counting fingers); three had monocular blindness already at diagnosis (no light perception, counting fingers, no fixation); three had 6/60 vision in the worse eye; and one had good vision bilaterally (6/10). Four children had direct optic nerve compression, four papilledema, and three gliomas. Four children (40%; with craniopharyngioma, pineal germinoma, or posterior fossa tumor) exhibited a rapid deterioration in vision after tumor depression (one direct optic nerve compression and three increased intracranial pressure); two had monocular visual loss postoperatively; vision remained stable in four (after ≥5 follow-up visits), but did not improve. This study shows that tumor-related optic neuropathy may be associated with marked visual loss inspite of successful tumor resection; in 40% of children, the deterioration occurs perioperatively. Direct compression is the main cause of visual loss, while papilledema usually resolved without visual sequelae. However, autoregulatory changes may be responsible for rapid visual loss following decompression for chronic papilledema. Clinicians need reminding about the problem of postoperative visual loss and we speculate on how it can be avoided.
本研究旨在描述一些脑肿瘤患儿并发视神经病变导致的严重术后不可逆性视力丧失。回顾了一家主要儿科三级中心的神经眼科服务的计算机数据库（2003-2008 年），以了解所有在最后一次随访检查时因脑肿瘤相关视神经病变而导致严重不可逆性视力丧失（数指或更差）的儿童。收集了年龄、性别、病因、首发症状和体征、手术前后及最后检查时的视力、神经影像学表现和治疗等数据。240 例患儿中 198 例接受了手术。其中 10 例（5%，5 男 5 女）符合研究标准。对 8 例患儿的初始视力检查数据进行了分析：1 例为双眼失明（不确定光感，数指）；3 例在诊断时即已单眼失明（无光感，数指，无固视）；3 例在较差眼的视力为 6/60；1 例双眼视力良好（6/10）。4 例有直接视神经受压，4 例有视乳头水肿，3 例有胶质瘤。4 例（40%，伴颅咽管瘤、松果体生殖细胞瘤或后颅窝肿瘤）在肿瘤减压后视力迅速恶化（1 例直接视神经受压，3 例颅内压增高）；2 例术后单眼视力丧失；4 例视力稳定（随访≥5 次），但无改善。本研究表明，尽管肿瘤已成功切除，但肿瘤相关性视神经病变仍可能导致明显的视力丧失；40%的患儿在围手术期出现病情恶化。直接压迫是导致视力丧失的主要原因，而视乳头水肿通常在无视力后遗症的情况下消退。然而，慢性视乳头水肿减压后可能会发生自动调节变化，导致视力迅速丧失。临床医生需要提醒注意术后视力丧失的问题，我们推测如何避免这种情况。
