Spectrum of visual disorders in children with cerebral visual impairment
Spectrum of visual disorders in children with cerebral visual impairment
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DOI：
10.1177/08830738070220030801
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发表时间：
2007-03-01
影响因子：
1.9
通讯作者：
Bianchi, Paolo Emilio
中科院分区：
文献类型：
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作者：
Fazzi, Elisa;Signorini, Sabrina Giovanna;Bianchi, Paolo Emilio
脑性视力障碍是在没有任何重大眼部疾病的情况下，由膝后回视通路损伤引起的视觉功能缺陷。这是发达国家儿童的主要视力缺陷。产前缺氧缺血性损伤是最常见的脑视力损害的原因，但病因是可变的。作者着手评估在患有中枢神经系统疾病的儿童样本中，非主要眼部病理导致的视力障碍的存在，并描述该队列中脑视力障碍的临床表现。121名中枢神经系统损伤和视力障碍患者接受了作者中心制定的一项方案，包括神经学、神经眼科学和神经放射学评估（脑磁共振成像）。121例患者中有105例视力下降，58例对比敏感度下降，88例眼震异常，7例视野缺损。58例患者的固定改变，95例患者的平滑追踪改变，41例患者的眼球运动改变。88例患者有斜视，43例患者有眼球运动异常。在27名可以接受评估的患者中，有24人的视觉感知能力受损。眼底异常和屈光不正是常见的相关表现。本研究证实，脑视觉障碍的临床表现可能是可变的，除了已经有充分记录的症状（如视力下降、视野缺损、对比敏感度降低）外，临床表现也可能以动眼病或视觉认知障碍为特征。脑性视力损害常与眼科异常有关，应仔细寻找。早期和仔细的评估，同时考虑到神经眼科学和眼科方面，对于正确诊断和个性化康复计划的发展是必不可少的。
Cerebral visual impairment is a visual function deficit caused by damage to the retrogeniculate visual pathways in the absence of any major ocular disease. It is the main visual deficit in children in the developed world. Preperinatal hypoxic-ischemic damage is the most frequent cause of cerebral visual impairment, but the etiology is variable. The authors set out to evaluate the presence of visual disorders not attributable to any major ocular pathology in a sample of children with central nervous system disease and to describe the clinical picture of cerebral visual impairment in this cohort. One hundred twenty-one patients with central nervous system damage and visual impairment underwent a protocol developed at the authors' center that included neurologic, neurophthalmologic, and neuroradiologic assessments (brain magnetic resonance imaging). Reduced visual acuity was found in 105 of 121 patients, reduced contrast sensitivity in 58, abnormal optokinetic nystagmus in 88, and visual field deficit in 7. Fixation was altered in 5 8 patients, smooth pursuit in 9 5, and saccadic movements in 41. Strabismus was present in 88 patients, and abnormal ocular movements were found in 43 patients. Of the 27 patients in whom they could be assessed, visual-perceptual abilities were found to be impaired in 24. Fundus oculi abnormalities and refractive errors were frequently associated findings. This study confirms that the clinical expression of cerebral visual impairment can be variable and that, in addition to already well-documented symptoms (such as reduced visual acuity, visual field deficits, reduced contrast sensitivity), the clinical picture can also be characterized by oculomotor or visual-cognitive disorders. Cerebral visual impairment is often associated with ophthalmologic abnormalities, and these should be carefully sought. Early and careful assessment, taking into account both the neurophthalmologic and the ophthalmologic aspects, is essential for a correct diagnosis and the development of personalized rehabilitation programs.