Ford Rebecca L, Lee Vickie, Xing Wen, Bunce Catey
Central Eye Service, Central Middlesex Hospital, North West London NHS Trust, London, United Kingdom.
J AAPOS. 2012 Oct;16(5):413-7. doi: 10.1016/j.jaapos.2012.04.009.
To report epidemiologic data on traumatic optic neuropathy (TON) in patients less than 18 years of age in the United Kingdom acquired by prospective population-based active surveillance through the British Ophthalmic Surveillance Unit.
Data were obtained from incident and 6-month follow-up questionnaires sent to reporting ophthalmologists over a period of 2 years. Main outcome measures were demographic data, clinical and visual function at presentation and follow-up, investigations, and treatments used.
A total of 26 cases (21 males) were identified; follow-up data were available for 23 (88%). Minimum estimated annual incidence was 0.99 cases per million. Leading causes of TON included 6 sports injuries (23%), 5 falls (19%), and 4 traffic accidents (16%). Presenting best-corrected visual acuity was ≤ 6/60 in 15 cases (58%), with no light perception in 7 cases (27%). Associated injuries were as follows: nonpenetrating injuries, 8 (31%); adnexal injuries, 3 (11.5%); orbital fractures, 5 (19%); skull fractures, 3 (12%); intracranial bleeding, 1 (4%). Fourteen (54%) received no treatment, and 9 (35%) were treated with steroids. Final visual acuity improved in 7 of 21 patients (33%), with 13 of 23 (56%) achieving final visual acuity ≤ 6/60, 10 of whom (43%) had no light perception. Baseline visual acuity was associated with last follow-up visual acuity (P = 0.03), but treatment and improvement of visual acuity by at least 3 lines were not associated. Treatment was more common in children with poor presenting vision (P = 0.03).
The incidence, natural history, poor presenting visual acuity, and male prevalence of TON in children appear similar to adults in adults in the UK.
通过英国眼科监测单位进行前瞻性人群主动监测，报告英国18岁以下创伤性视神经病变（TON）患者的流行病学数据。
数据来自在2年时间内发送给报告眼科医生的发病情况和6个月随访问卷。主要观察指标为人口统计学数据、就诊时及随访时的临床和视觉功能、检查及所用治疗方法。
共确定26例（21例男性）；23例（88%）有随访数据。最低估计年发病率为每百万人口0.99例。TON的主要病因包括6例运动损伤（23%）、5例跌倒（19%）和4例交通事故（16%）。就诊时最佳矫正视力≤6/60的有15例（58%），无光感的有7例（27%）。相关损伤情况如下：非穿透性损伤8例（31%）；附属器损伤3例（11.5%）；眼眶骨折5例（19%）；颅骨骨折3例（12%）；颅内出血1例（4%）。14例（54%）未接受治疗，9例（35%）接受了类固醇治疗。21例患者中有7例（33%）最终视力有所改善，23例中有13例（56%）最终视力≤6/60，其中10例（43%）无光感。基线视力与末次随访视力相关（P = 0.03），但治疗与视力至少提高3行之间无关联。视力差的儿童接受治疗更为常见（P = 0.03）。
英国儿童TON的发病率、自然病程、就诊时视力差以及男性患病率与成人相似。
