Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine.
Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine.
J AAPOS. 2021 Apr;25(2):95.e1-95.e5. doi: 10.1016/j.jaapos.2020.10.015. Epub 2021 Apr 20.
To evaluate the characteristics of diplopia in children at a single tertiary eye care center.
The medical records of patients with diplopia onset at age 18 years or younger presenting during the period 2015-2018 were reviewed retrospectively. Demographic information, clinical characteristics, diagnoses, treatment, and outcome data were collected. The exact χ test was used to compare groups and select post hoc analyses were performed using the Fisher exact or exact χ tests.
A total of 244 patients (average age, 12.2 years at presentation) were included. The most common clinical diagnoses were nonparalytic strabismus (49.2%), trauma (9.4%), and cranial nerve palsies (9%). There was no statistically significant difference in median age of diplopia onset in those with nonparalytic strabismus, cranial nerve palsies, and vision- or life-threatening conditions. There was a statistically significant difference in timing of onset of diplopia at presentation in vision- or life-threatening conditions compared to nonparalytic strabismus (P < 0.0001) and cranial nerve palsies (P = 0.01) and for neurologic symptoms in vision- or life- threatening conditions compared to nonparalytic strabismus (P = 0.032) and cranial nerve palsies (P = 0.0051). In patients with more than one neurologic symptom, the majority (58.3%) had a vision- or life-threatening condition. Initial interventions included observation (28.7%), prisms (18.4%), updating refractive correction (14.3%), and strabismus surgery (11.1%). In patients with follow-up data, 5.3% had resolution of diplopia prior to their clinic visit, and 46.6% had resolution after initial intervention.
In our study cohort, most children who presented with diplopia had nonemergent conditions. In those with life-threatening conditions, diplopia tended to have an acute onset and associated neurologic signs and visual symptoms.
评估单一三级眼科中心儿童复视的特征。
回顾性分析了 2015-2018 年期间发病年龄在 18 岁或以下的复视患者的病历资料。收集了人口统计学信息、临床特征、诊断、治疗和预后数据。采用确切的卡方检验比较组间差异，Fisher 确切检验或确切卡方检验用于选择事后分析。
共纳入 244 例患者（平均发病年龄为 12.2 岁）。最常见的临床诊断是非麻痹性斜视（49.2%）、创伤（9.4%）和颅神经麻痹（9%）。非麻痹性斜视、颅神经麻痹和视力或生命威胁性疾病患者的复视发病年龄中位数无统计学差异。视力或生命威胁性疾病患者的复视发病时间明显早于非麻痹性斜视（P<0.0001）和颅神经麻痹（P=0.01），且视力或生命威胁性疾病患者的复视发病时间也早于伴有神经系统症状的非麻痹性斜视（P=0.032）和颅神经麻痹（P=0.0051）。在有多种神经系统症状的患者中，大多数（58.3%）患有视力或生命威胁性疾病。初始干预措施包括观察（28.7%）、棱镜（18.4%）、更新屈光矫正（14.3%）和斜视手术（11.1%）。在有随访数据的患者中，5.3%的患者在就诊前复视已缓解，46.6%的患者在初始干预后复视缓解。
在本研究队列中，大多数出现复视的儿童为非紧急情况。在有生命威胁性疾病的患者中，复视往往为急性发作，并伴有神经系统症状和视觉症状。
