Yang L L, Lambert S R
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Ga., USA.
J Pediatr Ophthalmol Strabismus. 1995 Jan-Feb;32(1):37-41. doi: 10.3928/0191-3913-19950101-09.
The visual function of some children with structural defects of the macula or optic nerve has previously been shown to improve with occlusion therapy. The charts of five children, ages 4 to 8 years, who had various types of severe structural abnormalities were reviewed. Two patients had optic nerve hypoplasia; there was one case each of foveal hypoplasia, posterior persistent hyperplastic primary vitreous, and retinopathy of prematurity. All the patients had undergone extensive amblyopia therapy prior to referral. In three children, occlusion therapy had been initiated and continued intensively for several months or longer without recognizing the presence of a severe, underlying structural abnormality. In none of the five children was there any clear-cut evidence of visual improvement. In some cases, the long period of enforced iatrogenic vision impairment resulted in significant psychosocial harm and developmental delay. In all five cases, it was structural changes rather than amblyopia that ultimately accounted for visual loss. The authors stress the importance of a meticulous fundus examination directed at finding organic defects prior to patching. Close, periodic monitoring of visual function should then follow. To spare the child unnecessary psychosocial impairment, it is advisable to follow established recommended thresholds for terminating occlusion therapy.
先前已表明，一些患有黄斑或视神经结构缺陷的儿童的视觉功能可通过遮盖疗法得到改善。回顾了5名年龄在4至8岁之间、患有各种严重结构异常的儿童的病历。两名患者患有视神经发育不全；分别有1例中心凹发育不全、后部永存原始玻璃体增生症和早产儿视网膜病变。所有患者在转诊前均接受了广泛的弱视治疗。在3名儿童中，遮盖疗法已经开始并持续了数月或更长时间，却未发现严重的潜在结构异常。这5名儿童中没有任何明显的视力改善证据。在某些情况下，长期强制性医源性视力损害导致了严重的心理社会伤害和发育迟缓。在所有5例病例中，最终导致视力丧失的是结构变化而非弱视。作者强调在遮盖之前进行细致的眼底检查以发现器质性缺陷的重要性。随后应密切、定期监测视觉功能。为避免儿童遭受不必要的心理社会损害，建议遵循既定的终止遮盖疗法的推荐阈值。
