Department of Ophthalmology (HH, SRL), Stanford University School of Medicine, Palo Alto, California; and Department of Ophthalmology (HH), Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea.
J Neuroophthalmol. 2023 Mar 1;43(1):131-136. doi: 10.1097/WNO.0000000000001635. Epub 2022 Jun 14.
Traumatic brain injury (TBI) is one of the common causes of ocular motor nerve (oculomotor nerve [CN3], trochlear nerve [CN4], and abducens nerve [CN6]) palsies, but there has been no large study of ocular motor nerve palsy caused by TBI. This study aimed to investigate the characteristics of and differences in ocular motor nerve palsy after TBI, according to patient age and severity of TBI.
This was a population-based retrospective cohort study that included patients who had ocular motor nerve palsy after TBI with ≥6 months of continuous enrollment using claims data from the IBM MarketScan Research Databases (2007-2016). We assessed sex, age at the first diagnosis of TBI, the severity of TBI, and the rates of strabismus procedures according to the age and severity of TBI. The rates of muscle transposition surgery and chemodenervation in CN3, CN4, and CN6 palsy were investigated.
A total of 2,606,600 patients with TBI met the inclusion criteria. Among them, 1,851 patients (0.071%) had ocular motor nerve palsy after TBI. The median age of the patients was 39 (Q1-Q3: 19-54) years, and 42.4% of the patients were female. The median continuous enrollment period after the first diagnosis of TBI was 22 (Q1-Q3: 12-38) months. Of the 1,350,843 children with TBI, 454 (0.026%) had ocular motor nerve palsy. Of the 1,255,757 adults with TBI, 1,397 (0.111%) had ocular motor nerve palsy. Among these 1,851 patients, CN4 palsy (697, 37.7%) occurred most frequently, and strabismus procedures were performed in 237 patients (12.8%). CN6 palsy developed most frequently in children. More children (16.5%) underwent strabismus surgeries than adults (11.6%) ( P = 0.006). The proportion of CN4 palsy (52.3%) was higher while the proportion of CN3 palsy (15.5%) was lower in patients with mild TBI than in patients with moderate-to-severe TBI ( P < 0.001).
CN4 palsy developed most frequently among patients of all ages, and only approximately 13% of the patients underwent strabismus procedures for ocular motor nerve palsy after TBI. The rate of development of ocular motor nerve palsy was approximately 4.3 times lower in children than adults, and children most frequently had CN6 palsy after TBI.
创伤性脑损伤（TBI）是眼运动神经（动眼神经[CN3]、滑车神经[CN4]和展神经[CN6]）麻痹的常见原因之一，但尚无关于 TBI 引起的眼运动神经麻痹的大型研究。本研究旨在根据患者年龄和 TBI 严重程度，研究 TBI 后眼运动神经麻痹的特征和差异。
这是一项基于人群的回顾性队列研究，纳入了使用 IBM MarketScan 研究数据库（2007-2016 年）的索赔数据，连续登记≥6 个月的 TBI 后发生眼运动神经麻痹的患者。我们根据 TBI 的年龄和严重程度评估了性别、TBI 首次诊断时的年龄、TBI 的严重程度以及斜视手术的发生率。研究了 CN3、CN4 和 CN6 麻痹患者的肌肉移位手术和化学神经切断术的发生率。
共有 2606600 名 TBI 患者符合纳入标准。其中，1851 名（0.071%）患者 TBI 后发生眼运动神经麻痹。患者的中位年龄为 39 岁（四分位距 19-54 岁），42.4%为女性。TBI 首次诊断后连续登记的中位时间为 22 个月（四分位距 12-38 个月）。在 1350843 名儿童 TBI 患者中，有 454 名（0.026%）发生眼运动神经麻痹。在 1255757 名成人 TBI 患者中，有 1397 名（0.111%）发生眼运动神经麻痹。在这 1851 名患者中，最常见的是 CN4 麻痹（697 例，37.7%），有 237 名（12.8%）患者进行了斜视手术。儿童最常发生 CN6 麻痹。与成人（11.6%）相比，更多的儿童（16.5%）接受了斜视手术（P=0.006）。轻度 TBI 患者中 CN4 麻痹（52.3%）的比例较高，而 CN3 麻痹（15.5%）的比例较低（P<0.001）。
所有年龄段患者中最常见的是 CN4 麻痹，仅有约 13%的 TBI 后眼运动神经麻痹患者接受了斜视手术。儿童眼运动神经麻痹的发生率约为成人的 4.3 倍，儿童 TBI 后最常发生 CN6 麻痹。
