Department of Ophthalmology (MAN), University Medical Center Utrecht, Utrecht University, GA Utrecht, the Netherlands; Department of Ophthalmology (IS, GLP, MBvE-E, DCPvdL, SMI), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Otorhinolaryngology and Head & Neck Surgery University (IS), University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus (IS), University Medical Center Utrecht, Utrecht, the Netherlands; Epidemiology and Data Science (IS), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Faculty of Medicine (JCD), Utrecht University, Utrecht, the Netherlands; and Department of Neuro-Oncology (EWH, AYNS-vM), Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
J Neuroophthalmol. 2022 Mar 1;42(1):e99-e108. doi: 10.1097/WNO.0000000000001421. Epub 2021 Oct 29.
Children with a brain tumor are prone to develop visual impairment, which to date is often underestimated and unrecognized. Our aim was to assess the prevalence of ophthalmological evaluation and abnormal ophthalmological findings, and investigate whether demographic and tumor-related characteristics are associated with abnormal ophthalmological findings in children presenting with a primary brain tumor.
Medical records of all 90 children diagnosed with a primary brain tumor between June 2018 and May 2019 and treated at the Princess Máxima Center for Pediatric Oncology, a tertiary referral center in the Netherlands, were retrospectively reviewed. Univariate regression analysis was used to investigate associations between demographic, tumor-related and clinical characteristics, and abnormal ophthalmological findings.
Sixty children (34 male [56.7%]; median [range] age, 9.3 [0-16.9] years) underwent ophthalmological evaluation within 6 weeks before or after diagnosis, 11 children (5 male [45.5%]; median [range] age, 5.7 [0.1-17.2] years) were seen more than 6 weeks before or after diagnosis, and 19 children (7 male [36.8%]; median [range] age, 7.2 [1.9-16.6] years) did not receive ophthalmological evaluation within at least 6 months from diagnosis. A total of 19 children (21.1%) presented with visual symptoms as first sign leading to the diagnosis of a brain tumor. Children who presented with visual symptoms (odds ratio [OR], 22.52; 95% confidence interval [CI], 4.90-103.60) and/or hydrocephalus (OR, 3.60; 95% CI, 1.38-9.36) at diagnosis were more often seen for ophthalmological evaluation. The most common abnormal ophthalmological findings were eye movement disorders (66.0%), papilledema (44.1%), and visual field defects (58.1%). Eye movement disorders occurred more frequently in patients with an infratentorial tumor (OR, 4.71; 95% CI, 1.03-21.65). The risk of papilledema was associated with older age (OR, 1.19; 95% CI, 1.05-1.34), hydrocephalus (OR, 9.63; 95% CI, 2.68-34.61), and infratentorial (OR, 9.11; 95% CI, 1.77-46.78) and supratentorial (OR, 13.13; 95% CI, 1.92-89.52) tumors.
In this study, most children with a primary brain tumor underwent ophthalmological evaluation around diagnosis, 21% of the children were not evaluated. The high prevalence of abnormal ophthalmological findings stresses the importance of early standardized ophthalmological evaluation to detect visual impairment and provide timely treatment to potentially prevent permanent visual loss.
患有脑瘤的儿童容易出现视力障碍，迄今为止，这种情况往往被低估和忽视。我们的目的是评估眼科评估和异常眼科发现的发生率，并调查在出现原发性脑肿瘤的儿童中，人口统计学和肿瘤相关特征是否与异常眼科发现相关。
回顾性分析 2018 年 6 月至 2019 年 5 月在荷兰 Princess Máxima 儿科肿瘤中心接受治疗的 90 名原发性脑肿瘤患儿的病历。采用单变量回归分析调查人口统计学、肿瘤相关和临床特征与异常眼科发现之间的关联。
60 名儿童（34 名男性[56.7%]；中位[范围]年龄 9.3[0-16.9]岁）在诊断前或后 6 周内接受了眼科评估，11 名儿童（5 名男性[45.5%]；中位[范围]年龄 5.7[0.1-17.2]岁）在诊断前或后 6 周以上接受了眼科评估，19 名儿童（7 名男性[36.8%]；中位[范围]年龄 7.2[1.9-16.6]岁）在诊断后至少 6 个月内未接受眼科评估。共有 19 名儿童（21.1%）以视觉症状为首发症状导致脑瘤的诊断。出现视觉症状（比值比[OR]，22.52；95%置信区间[CI]，4.90-103.60）和/或诊断时出现脑积水（OR，3.60；95% CI，1.38-9.36）的儿童更常接受眼科评估。最常见的异常眼科发现是眼球运动障碍（66.0%）、视盘水肿（44.1%）和视野缺损（58.1%）。眼球运动障碍在幕下肿瘤患者中更为常见（OR，4.71；95% CI，1.03-21.65）。视盘水肿的风险与年龄较大（OR，1.19；95% CI，1.05-1.34）、脑积水（OR，9.63；95% CI，2.68-34.61）以及幕下（OR，9.11；95% CI，1.77-46.78）和幕上（OR，13.13；95% CI，1.92-89.52）肿瘤有关。
在这项研究中，大多数患有原发性脑肿瘤的儿童在诊断时接受了眼科评估，而 21%的儿童未接受评估。异常眼科发现的高发生率强调了早期进行标准化眼科评估的重要性，以发现视力障碍并及时提供治疗，从而有可能防止永久性视力丧失。
