Kelly John P, Feldman Kenneth, Wright Jason, Ganti Sheila, Metz James B, Weiss Avery
Roger H. Johnson Vision Clinic, Seattle Children's Hospital, Division of Ophthalmology, OA.5.342, Seattle, WA, 98105, USA.
Department of Ophthalmology, University of Washington, Seattle, USA.
Doc Ophthalmol. 2020 Oct;141(2):111-126. doi: 10.1007/s10633-020-09756-1. Epub 2020 Feb 12.
To investigate retinal function and visual outcomes in infants with retinal hemorrhages due to non-accidental trauma (NAT).
This is a retrospective review of full-field or multifocal electroretinogram (ERG) recordings, visual acuity in log minimum angle of resolution (logMAR), clinical status, and neuroimaging. Multifocal ERGs from the central 40° were compared to corresponding fundus imaging. Visual acuity was measured by Teller cards at follow-up. ERGs were compared to controls recorded under anesthesia.
Sixteen children met inclusion criteria (14 recorded during the acute phase and 2 during long-term follow-up). During the acute phase, ERGs (n = 4 full field; n = 10 multifocal ERG) showed abnormal amplitude, latency, or both in at least one eye. Ten subjects had significantly reduced responses in both eyes, 3 of which had an ERG dominated by a negative waveform (absent b-wave or P1). The remaining six subjects had responses in one eye that were near normal (≥ 50% of controls). ERGs were sometimes abnormal in local areas without hemorrhage. ERGs could be preserved in local areas adjacent to traumatic retinoschisis. Two subjects with reduced visual acuity had belated ERGs: One had an abnormal macular ERG and the other had a normal macular ERG implying cortical visual impairment. At follow-up, 10 of 14 subjects had significant visual acuity loss (≥ 0.7 age-corrected logMAR); four subjects had mild vision loss (≤ 0.5 age-corrected logMAR). Visual acuity outcome was not reliably associated with the fundus appearance in the acute phase. All subjects with a negative ERG waveform had severe vision loss on follow-up.
Retinal dysfunction was common during the acute phase of NAT. A near normal appearing fundus did not imply normal retinal function, and ERG abnormality did not always predict a poor visual acuity outcome. However, a negative ERG waveform was associated severe visual acuity loss. Potential artifacts of retinal hemorrhages and anesthesia could not fully account for multifocal ERG abnormalities. Retinal function can be preserved in areas adjacent to traumatic retinoschisis.
研究因非意外创伤（NAT）导致视网膜出血的婴儿的视网膜功能和视觉预后。
这是一项对全视野或多焦视网膜电图（ERG）记录、以最小分辨角对数（logMAR）表示的视力、临床状况和神经影像学的回顾性研究。将中央40°的多焦ERG与相应的眼底成像进行比较。随访时通过泰勒卡片测量视力。将ERG与麻醉下记录的对照组进行比较。
16名儿童符合纳入标准（14名在急性期记录，2名在长期随访期间记录）。在急性期，ERG（n = 4例全视野；n = 10例多焦ERG）显示至少一只眼睛的振幅、潜伏期异常或两者均异常。10名受试者双眼反应明显降低，其中3名受试者的ERG以负向波为主（b波或P1波缺失）。其余6名受试者一只眼睛的反应接近正常（≥对照组的50%）。ERG在无出血的局部区域有时也会异常。ERG可在创伤性视网膜劈裂附近的局部区域得以保留。两名视力下降的受试者ERG延迟：一名黄斑ERG异常，另一名黄斑ERG正常，提示皮质性视觉障碍。随访时，14名受试者中有10名有明显视力丧失（≥0.7年龄校正logMAR）；4名受试者有轻度视力丧失（≤0.5年龄校正logMAR）。急性期的视力预后与眼底外观无可靠关联。所有ERG波形为负向的受试者随访时均有严重视力丧失。
NAT急性期视网膜功能障碍很常见。眼底外观接近正常并不意味着视网膜功能正常，ERG异常也并不总是预示视力预后不良。然而，ERG波形为负向与严重视力丧失相关。视网膜出血和麻醉的潜在伪迹不能完全解释多焦ERG异常。创伤性视网膜劈裂附近的区域视网膜功能可得以保留。
