Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, CA, USA.
Am J Ophthalmol. 2019 Oct;206:235-244. doi: 10.1016/j.ajo.2019.04.008. Epub 2019 Apr 17.
To determine the frequency of occurrence of receded near point of convergence (NPC) in patients with chronic concussion-related symptoms and in those with receded NPC to enumerate the frequency of convergence insufficiency and other oculomotor disorders.
Retrospective cross-sectional study.
Clinic charts were retrospectively reviewed for the prior 3.5 years to identify all patients < 21 years old who were > 28 days postconcussion, had chronic concussion-related symptoms, had normal visual acuity, and had received a comprehensive sensorimotor examination. The frequency of receded NPC and oculomotor diagnoses were determined.
Of the 83 eligible patients, 74 (89%) had receded NPC. Of these, 70 (95%) had oculomotor disorders; 30 (41%) had disorders of accommodation only; 21 (28%) had convergence insufficiency and accommodation deficits; and 6 (8%) had convergence insufficiency only. Six (8%) had a convergence deficit other than convergence insufficiency (all with concurrent accommodative disorders); 4 (5%) had both a nonspecific vergence dysfunction and accommodation deficits; 2 (3%) had convergence excess only; and 1 (1%) had both convergence excess and accommodative deficits.
A receded NPC was present in the majority of young patients with chronic postconcussion symptoms. Associated with numerous underlying oculomotor dysfunctions, the clinical finding of a receded NPC is not synonymous with the diagnosis of convergence insufficiency. Because treatment options for the various oculomotor dysfunctions differ, it is prudent that these patients undergo a thorough examination of their vergence and accommodative systems so that an accurate diagnosis can be made and appropriate treatment prescribed.
确定慢性脑震荡相关症状患者和近点集合退缩（NPC）患者的 NPC 退缩频率，以列举集合不足和其他眼球运动障碍的频率。
回顾性横断面研究。
回顾性查阅过去 3.5 年的临床图表，以确定所有<21 岁、>28 天脑震荡后、有慢性脑震荡相关症状、视力正常且接受全面感觉运动检查的患者。确定 NPC 退缩的频率和眼球运动诊断。
在 83 名符合条件的患者中，74 名（89%）有 NPC 退缩。其中 70 名（95%）有眼球运动障碍；30 名（41%）仅存在调节障碍；21 名（28%）存在集合不足和调节不足；6 名（8%）仅存在集合不足。6 名（8%）存在除集合不足以外的集合不足（均伴有同时存在的调节障碍）；4 名（5%）存在非特异性聚散功能障碍和调节不足；2 名（3%）仅存在集合过度；1 名（1%）存在集合过度和调节不足。
大多数患有慢性脑震荡后症状的年轻患者存在 NPC 退缩。与许多潜在的眼球运动功能障碍相关，NPC 退缩的临床发现与集合不足的诊断并不相同。由于各种眼球运动功能障碍的治疗选择不同，因此这些患者应进行全面的聚散和调节系统检查，以便做出准确的诊断并开出适当的治疗方案。
