Duncan Jared E, Freedman Sharon F, El-Dairi Mays A
Ophthalmology Associates of Greater Annapolis, Arnold, Maryland.
Duke Eye Center, Durham, North Carolina.
J AAPOS. 2016 Feb;20(1):44-8. doi: 10.1016/j.jaapos.2015.10.013.
To evaluate the incidence of visual field defects and choroidal neovascular membranes (CNVM) in a cohort of pediatric patients with optic nerve head drusen (ONHD).
The medical records of children with ONHD seen at a single center from January 2012 to July 2014 were retrospectively reviewed to identify patients who had a dilated fundus examination, fundus photography, spectral domain optical coherence tomography (SD-OCT)/enhanced-depth imaging (EDI) of the optic nerve head (ONH), SITA fast 24-2 Humphrey visual field (HVF) testing, lumbar puncture, and ocular ultrasound. A masked neuro-ophthalmologist analyzed fundus photographs, OCT, and fields. Retinal nerve fiber layer (RNFL) data were compared to age-matched controls.
A total of 52 children (98 eyes) were included. Mean age was 10.8 ± 3.3 years. Of these, 42 patients had visual fields (57 eyes deemed reliable), and 19 eyes had documented visual field deficits (8 were reproducible across ≥1 sitting [frequency 14%]). After correction of plotting errors (40 eyes), RNFL thickness was 111.9 ± 17.9 μm. CNVM were present in 24 of 98 eyes (24.5%), with 21 of 24 located nasally (87.5%). Neither RNFL thinning nor identification of ONHD on fundus photography correlated with the presence of visual field defects.
Visual field defects due to ONHD can be reliably identified in children. In eyes of children with ONHD, RNFL protocol is frequently unreliable and may overestimate RNFL thickness. EDI scans through the ONH revealed peripapillary CNVM in nearly a quarter of the patients. Further longitudinal studies looking at the progression of CNVM and visual field deficits are warranted.
评估一组患有视神经乳头 drusen（ONHD）的儿科患者中视野缺损和脉络膜新生血管膜（CNVM）的发生率。
回顾性分析 2012 年 1 月至 2014 年 7 月在单一中心就诊的 ONHD 患儿的病历，以确定接受过散瞳眼底检查、眼底照相、视神经乳头（ONH）的光谱域光学相干断层扫描（SD-OCT）/增强深度成像（EDI）、SITA 快速 24-2 Humphrey 视野（HVF）检测、腰椎穿刺和眼部超声检查的患者。一位经验丰富的神经眼科医生分析眼底照片、OCT 和视野。将视网膜神经纤维层（RNFL）数据与年龄匹配的对照组进行比较。
共纳入 52 名儿童（98 只眼）。平均年龄为 10.8 ± 3.3 岁。其中，42 例患者进行了视野检查（57 只眼被认为可靠），19 只眼记录有视野缺损（8 只在≥1 次检查中可重复[频率 14%]）。校正绘图误差后（40 只眼），RNFL 厚度为 111.9 ± 17.9μm。98 只眼中有 24 只（24.5%）存在 CNVM，其中 24 只中有 21 只位于鼻侧（87.5%）。眼底照相中 RNFL 变薄或 ONHD 的识别均与视野缺损的存在无关。
儿童中由 ONHD 导致的视野缺损可以可靠地识别。在患有 ONHD 的儿童眼中，RNFL 检测方案通常不可靠，可能高估 RNFL 厚度。通过 ONH 的 EDI 扫描在近四分之一的患者中发现了视乳头周围 CNVM。有必要进行进一步的纵向研究以观察 CNVM 和视野缺损的进展情况。
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