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颅缝早闭中的视神经病变。

Optic neuropathy in craniosynostosis.

作者信息

Estrela Tais, Dagi Linda R

机构信息

Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.

出版信息

Front Ophthalmol (Lausanne). 2024 Jan 10;3:1303723. doi: 10.3389/fopht.2023.1303723. eCollection 2023.

Abstract

Craniosynostosis (CS) or the premature fusion of one or more cranial sutures , or during the first years of life, can present in isolation or as a multisystem clinical disorder with a particular impact on visual function. Among ophthalmic complications, optic neuropathy is a significant cause of irreversible vision loss in these patients. Children with CS are at higher risk of developing elevated intracranial pressure which can lead to papilledema and, ultimately, optic atrophy. In addition, sometimes associated obstructive sleep apnea, abnormalities in central nervous system venous development, and Chiari malformation may contribute to optic neuropathy. Ophthalmologists have an important role in managing a number of coexistent ophthalmologic complications such as strabismus, anisometropia, amblyopia, ptosis, and exposure keratopathy in addition to maintaining surveillance for early signs of optic neuropathy; they play a critical consultative role contributing to the decision for primary or repeat decompressive surgery. In this article, we aim to review the etiology, diagnostic approach, and management of optic neuropathies in patients with craniosynostosis.

摘要

颅缝早闭(CS)即一条或多条颅缝在生命的最初几年过早融合,可单独出现,也可作为一种多系统临床疾病出现,对视觉功能有特殊影响。在眼科并发症中,视神经病变是这些患者不可逆视力丧失的重要原因。患有颅缝早闭的儿童发生颅内压升高的风险更高,这可能导致视乳头水肿,并最终导致视神经萎缩。此外,有时伴发的阻塞性睡眠呼吸暂停、中枢神经系统静脉发育异常和Chiari畸形可能导致视神经病变。眼科医生在管理多种并存的眼科并发症(如斜视、屈光参差、弱视、上睑下垂和暴露性角膜病变)方面发挥着重要作用,此外还需监测视神经病变的早期迹象;他们在决定进行初次或再次减压手术方面发挥着关键的咨询作用。在本文中,我们旨在综述颅缝早闭患者视神经病变的病因、诊断方法和治疗。

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本文引用的文献

1
Sensitivity, Specificity, and Cutoff Identifying Optic Atrophy by Macular Ganglion Cell Layer Volume in Syndromic Craniosynostosis.
Ophthalmology. 2024 Mar;131(3):341-348. doi: 10.1016/j.ophtha.2023.09.022. Epub 2023 Sep 22.
5
Optic Nerve Atrophy in Syndromic Craniosynostosis.
Plast Reconstr Surg. 2022 Aug 1;150(2):381e-386e. doi: 10.1097/PRS.0000000000009367. Epub 2022 Jun 8.
7
Optic canal characteristics in pediatric syndromic craniosynostosis.
J Craniomaxillofac Surg. 2021 Dec;49(12):1175-1181. doi: 10.1016/j.jcms.2021.06.017. Epub 2021 Jun 24.
10
Long-term ophthalmic outcomes in 120 children with unilateral coronal synostosis: a 20-year retrospective analysis.
J AAPOS. 2021 Apr;25(2):76.e1-76.e5. doi: 10.1016/j.jaapos.2020.10.013. Epub 2021 Mar 11.

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