摘要
目的观察儿童牵牛花综合征（MGS）并发视网膜脱离（RD）的临床特征和治疗效果。方法回顾分析经双目间接检眼镜、眼部B型超声、广角数码视网膜成像系统眼底照相、头颅磁共振和（或）磁共振脑血管造影检查确诊的49例MGS并发RD患儿51只眼的资料。其中，男性27例27只眼，女性22例24只眼。确诊时年龄为出生后1周～13岁，平均年龄（4．2±3．2）岁。RD类型能明确为渗出性RD者33只眼，孔源性RD者3只眼，其余15只眼不能明确RD类型。有20例20只眼合并其他先天性眼部异常。包括永存原始玻璃体增生症、先天性小眼球、脉络膜缺损、虹膜缺损。除并发RD外，还可并发白内障、瞳子L后黏连、继发性青光眼、角膜混浊、斜视、眼球震颤。22例22只眼进行了治疗。5例5只轻度渗出性RD眼患儿予口服醋甲唑胺治疗；3例3只眼行视盘周围激光光凝治疗；14例14只眼行手术治疗。手术治疗的14只眼中，6只眼仅MGS并发RD，行玻璃体切割手术，其中3只眼联合品状体切除手术；8只眼伴继发性青光眼和并发性白内障，行单纯晶状体切除手术或超声乳化自内障吸除手术。治疗后随访时间均在3个月以上，平均随访时间（20．3土11．8）个月。对比治疗前后患儿视力、视网膜复位情况以及有无眼压升高等并发症。结果5例口服醋甲唑胺治疗者随访期间病情稳定，RD未加重。3例视盘周围激光光凝治疗者中，2例病情稳定，1例在2次激光光凝治疗后RD范围扩大。行晶状体切除或超声乳化白内障吸除手术的8只眼中，手术后白内障解除，前房形成、眼压下降。行玻璃体切割手术的6只眼中，手术后视网膜平伏。进行治疗的患儿中，10例10只眼配合行视力检查。其中，1只激光光凝治疗眼的视力由治疗前手动提高至治疗后眼前数指，9只眼视力维持不变。未见其他与药物和手术治疗相关的并发症。结论儿童MGS并发RD最早可发生在出生后1周，患儿往往还合并其他先天性眼部异常或眼疾病。定期随访，尽早发现RD，结合患儿病情进行药物、激光光凝或手术治疗，对保存患儿视功能有重要意义。
Objective To analyze and discuss the clinical features and management of pediatric retinal detachment （RD） associated with morning glory syndrome （MGS）. Methods The clinical data of 49 patients （51 eyes） with RD associated with MGS were retrospectively analyzed, including 27 males （27 eyes） and 22 females （24 eyes）. The age at first diagnosis ranged from 1 week after birth and 13 years old （4.2-＋-3.2） years. There were 33 eyes of exudative RD, 3 eyes of rhegmatogenous RD and 15 eyes of RD with undetermined cause. Twenty eyes of 20 patients had other congenital ocular abnormalities, including persistent hyperplastic primary vitreous, microphthalmia, choroidal coloboma, iris coloboma. Besides retinal detachment, other complications were found, including cataract, secondary glaucoma, corneal leukoma or edema, strabismus and nystagmus. Twenty two cases （22 eyes） received treatment. Five cases of mild exudative retinal detachment took oral methazolamide tablets. Three eyes with mild and restricted retinal detachments got retinal laser photocoagulation around the optic disc. Fourteen cases of 14 eyes underwent surgery including vitrectomy, lensectomy, and phacoemulsification. Follow-up after treatment were three months or more, with an average of （20.3~11.8） months. The visual acuity, retinal reattachment and intraocular pressure and other complications after treatment were followed up. Results Five patients of exudative retinal detachment were remained stable by taking methazolamide tablets. Two of the 3 eyes remained stable after laser therapy; however, the remaining one eye was not controlled after relaser. Cataract and glaucoma were resolved by lensectomy in 7 eyes and phaco emulsification surgery in 1 eye. Retina was re attached in 6 eyes after vitrectomy. Among those treated, 10 eyes had records of visual acuity. Visual acuity was improved in 1 eye after laser therapy and remained stable in 9 eyes. There were no drugs and surgery-related complications. Conclusions Retinal detachment was the main complication of MGS. The high incidence and poor prognosis call for the need of close follow-up and timely treatment, including medicine, laser and surgery.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2014年第1期46-49,共4页
Chinese Journal of Ocular Fundus Diseases
基金
国家自然科学基金面上项目（81271045）
