Yokoyama Toshiyuki
Juntendo Iji Zasshi. 2024 Mar 28;70(2):104-111. doi: 10.14789/jmj.JMJ23-0040-R. eCollection 2024.
Several problems differentiate the treatment of children, especially those with congenital ocular disease, from adults, including the absence of complaints and the complication of systemic diseases. However, the most challenging is the continuing developing anatomical and functional development and immaturity in children. Consequently, the timing of disease onset and treatment can greatly affect the prognosis, and the prognosis cannot be confirmed without long-term follow-up periods. The prognosis for unilateral congenital cataract is very poor. However, some cases achieved good vision with successful refractive correction and amblyopia therapy, suggesting that long-term parental enthusiasm and adherence are important for the visual prognosis. Penetrating keratoplasty is rarely performed in children, and outcomes at our hospital have been extremely poor for congenital corneal opacity over the past 28 years. The visual prognosis is also poor for large limbal dermoids approaching the center of the cornea, which did not respond to preoperative amblyopia therapy. Consequently, early excision, lamellar keratoplasty, wearing of hard contact lenses, and amblyopia therapy were considered necessary. Treatment of pediatric ocular disease should consider the pros and cons, methods, and timing, especially the development of the pediatric eye and the time of onset of the disease.
儿童(尤其是患有先天性眼病的儿童)的治疗与成人的治疗存在几个不同之处,包括儿童不会诉说病情以及存在全身性疾病并发症。然而,最具挑战性的是儿童持续发育的解剖结构和功能以及发育不成熟。因此,疾病的发病时间和治疗时机可能会极大地影响预后,而且没有长期随访期就无法确定预后。单侧先天性白内障的预后非常差。然而,一些病例通过成功的屈光矫正和弱视治疗获得了良好视力,这表明家长长期的热情和坚持对视力预后很重要。穿透性角膜移植术在儿童中很少进行,在过去28年里,我院先天性角膜混浊的手术效果极差。对于接近角膜中心的大型角膜缘皮样瘤,其视觉预后也很差,术前弱视治疗对此无效。因此,早期切除、板层角膜移植术、佩戴硬性隐形眼镜以及弱视治疗被认为是必要的。小儿眼病的治疗应考虑利弊、方法和时机,尤其是小儿眼睛的发育情况和疾病的发病时间。