印度人群中儿童视神经炎的视觉结果和临床表现：一项机构研究。

Visual Outcomes and Clinical Manifestations of Pediatric Optic Neuritis in Indian Population: An Institutional Study.

机构信息

Departments of Neuro Ophthalmology (SA and PKL) and Radiology (OVN), Sankara Nethralaya, A Unit of Medical Research Foundation, Chennai, India; and Department of Neurology (VV), Kanchi Kamakoti Child Trust Hospital, Chennai, India.

出版信息

J Neuroophthalmol. 2018 Dec;38(4):462-465. doi: 10.1097/WNO.0000000000000646.

DOI:10.1097/WNO.0000000000000646

PMID:29554001

Abstract

BACKGROUND

Optic neuritis in children is an uncommon disorder which usually occurs after a viral illness or vaccination and, less frequently, occurs as a manifestation of a demyelinating disorder. Pediatric optic neuritis usually is bilateral and presents with optic disc edema, recovers rapidly with steroid therapy, and generally has low conversion rate to multiple sclerosis or neuromyelitis optica spectrum disorder. We report the clinical features and treatment outcomes of pediatric optic neuritis in Indian population, for which little data are available.

METHODS

We reviewed the medical case records of patients with optic neuritis who were younger than 18 years, from 1999 to 2016. All patients were assessed and managed in the Neuro-Ophthalmology Department of Sankara Nethralaya, a unit of Medical Research Foundation and Pediatric Neurology Department of Kanchi Kamakoti-Childs Trust Hospital, Chennai, India.

RESULTS

One hundred seventeen eyes of 78 children with mean age of 11.84 (±4.58) years were identified. Forty-two (53.8%) were females and 36 (46.2%) were males. Thirty-nine patients (50%) had bilateral involvement and a similar number had unilateral involvement. Fifty-nine eyes (50.4%) had optic disc edema, 20 eyes (17.1%) had disc pallor, and 38 eyes (32.4%) had normal discs. Of 63 patients who had neuroimaging, 36 had MRI, and 27 underwent computed tomography. Eighty-four eyes (of 59 patients) received steroid therapy according to the protocol of the Optic Neuritis Treatment Trial (ONTT). Thirty-three eyes that were treated with other steroid protocols were excluded from the final visual outcome analyses. Sixty of the 84 eyes (72.3%) recovered visual acuity of 20/40 or better. Visual acuity improvement was statistically significant between initial and final visual acuity (logMAR) in our patients treated with the ONTT protocol (P ≤ 0.001).

CONCLUSIONS

Our Indian pediatric population had good visual recovery after steroid treatment for optic neuritis. Profound loss of visual acuity on presentation and bilateral involvement were significantly associated with poor visual outcome.

摘要

背景

儿童视神经炎是一种罕见疾病，通常在病毒感染或疫苗接种后发生，较少情况下作为脱髓鞘疾病的表现。儿科视神经炎通常为双侧，表现为视盘水肿，用类固醇治疗后迅速恢复，总体多发性硬化或视神经脊髓炎谱系障碍转化率较低。我们报告了印度人群中儿科视神经炎的临床特征和治疗结果，这方面的数据很少。

方法

我们回顾了 1999 年至 2016 年期间年龄小于 18 岁的视神经炎患者的病历。所有患者均在印度金奈的 Sankara Nethralaya 的神经眼科部门、Medical Research Foundation 的一个单位以及 Kanchi Kamakoti-Childs Trust Hospital 的儿科神经科接受评估和管理。

结果

共确定了 78 例儿童 117 只眼，平均年龄为 11.84（±4.58）岁。其中 42 例（53.8%）为女性，36 例（46.2%）为男性。39 例（50%）为双侧受累，相似数量为单侧受累。59 只眼（50.4%）有视盘水肿，20 只眼（17.1%）视盘苍白，38 只眼（32.4%）视盘正常。在接受神经影像学检查的 63 例患者中，36 例进行了 MRI，27 例进行了 CT。根据视神经炎治疗试验（ONTT）的方案，63 例中有 84 只眼（59 例）接受了类固醇治疗。33 只眼因接受其他类固醇方案治疗而被排除在最终视力结果分析之外。84 只眼中的 60 只（72.3%）视力恢复到 20/40 或更好。在接受 ONTT 方案治疗的患者中，初始和最终视力（logMAR）之间的视力改善具有统计学意义（P≤0.001）。