脑室扩张 3 或 4 级室管膜下出血后 10 年儿童的视力功能：一项盲法前瞻性研究。
Vision function in children 10 years after grade 3 or 4 intraventricular haemorrhage with ventricular dilation: A masked prospective study.
机构信息
Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK.
Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
出版信息
Dev Med Child Neurol. 2023 Feb;65(2):223-231. doi: 10.1111/dmcn.15294. Epub 2022 Jun 23.
AIM
We examined children 10 to 11 years after grade 3 or 4 intraventricular haemorrhage and ventricular dilation (IVHVD) and investigated whether the grade of IVHVD affected their visual outcome. We explored associations between visual outcomes with cognitive outcomes and extra support at school.
METHOD
The visual examinations were part of a 10-year follow-up study for children in a randomized trial. Testers followed a protocol and were masked to whether the child had experienced grade 3 or grade 4 IVHVD and all other data.
RESULTS
Thirty-two children were tested: 24 were male and mean (standard deviation) age was 10 years 5 months (1 year 2 months); range 8 years 9 months to 12 years 9 months. All had at least one visual impairment. The median (interquartile range) number of impairments per child was six (six to nine) for children who experienced a grade 4 IVHVD compared with three (two to four) for children who experienced a grade 3 IVHVD (p = 0.003). Each extra vision impairment per child was associated with increased educational support at school, after adjustment for developmental age equivalence (odds ratio = 1.7 [95% confidence interval 1.1-2.6], p = 0.015).
INTERPRETATION
Children who experience grade 3 or 4 IVHVD have a high level of visual morbidity at age 10 to 11 years. These children may have unmet visual needs and their outcomes might improve if these needs could be addressed.
WHAT THIS PAPER ADDS
Parent-reported questionnaire responses underestimated directly assessed visual morbidity. Grade 4 intraventricular haemorrhage and ventricular dilatation (IVHVD) was followed by more vision impairments than grade 3 IVHVD. Simple tests of visual perceptual skills correlated with the neuropsychology tests. Children with supranuclear eye movement disorders were more likely to be receiving extra help at school. Each additional visual impairment increased the likelihood of extra educational support.
目的
我们研究了患有 3 或 4 级脑室内出血和脑室扩张（IVHVD）的 10 至 11 岁儿童，并调查了 IVHVD 的严重程度是否会影响他们的视觉结果。我们探讨了视觉结果与认知结果和学校额外支持之间的关系。
方法
视觉检查是一项针对随机试验中儿童进行的 10 年随访研究的一部分。测试人员遵循一个方案，对孩子是否经历过 3 级或 4 级 IVHVD 以及所有其他数据均不知情。
结果
共有 32 名儿童接受了测试：24 名男性，平均（标准差）年龄为 10 岁 5 个月（1 岁 2 个月）；范围 8 岁 9 个月至 12 岁 9 个月。所有儿童均至少存在一种视力障碍。经历 4 级 IVHVD 的儿童中，每个儿童有 6 种（6 到 9 种）损伤，而经历 3 级 IVHVD 的儿童中，每个儿童有 3 种（2 到 4 种）损伤（p=0.003）。在调整发育年龄等效性后，每个儿童多一种视力障碍与学校获得更多教育支持相关（比值比=1.7[95%置信区间 1.1-2.6]，p=0.015）。
结论
经历 3 级或 4 级 IVHVD 的儿童在 10 至 11 岁时视觉发病率较高。这些儿童可能存在未满足的视觉需求，如果能够解决这些需求，他们的结果可能会得到改善。
本文的新发现
家长报告的问卷调查结果低估了直接评估的视觉发病率。4 级脑室内出血和脑室扩张（IVHVD）比 3 级 IVHVD 导致更多的视力障碍。视觉感知技能的简单测试与神经心理学测试相关。有核上性眼球运动障碍的儿童更有可能在学校获得额外帮助。每增加一种视力障碍，就会增加获得额外教育支持的可能性。
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