摘要
目的:采用多项客观指标综合评估脑瘫患儿视觉功能,探讨脑瘫患儿的视觉障碍的临床特点。方法:对43例86眼眼部有视觉障碍脑瘫患儿进行眼追随实验、视动性眼震、屈光、眼底、斜视、图形视觉诱发电位(pattern visual evoked potential,P-VEP)及头颅磁共振成像(magnetic resonance imaging,MRI)等客观指标检查;对脑瘫患儿的视觉功能进行综合评估,分析不同性质脑瘫患儿的视觉障碍发生特点和可能机制。结果:(1)43例86眼合并视觉障碍患儿中,25例50眼(58.1%)脑瘫患儿发现屈光不正;24例48眼(55.8%)患儿存在斜视;12例24眼(27.9%)患儿伴有眼球震颤;19例38眼(44.2%)眼底视神经萎缩或者发育异常;35例70眼(81.4%)患儿VEP表现为异常;其中痉挛型脑瘫患儿中视觉障碍发生率与其他各组差异有显著统计学意义(P<0.01);(2)脑瘫患儿中内斜视发生者为16例32眼(37.2%),外斜视发生者为6例12眼(14.0%),垂直斜视发生者为2例4眼(4.7%)。痉挛性脑瘫中斜视最多见,发生者为13例26眼(30.2%),并都表现为内斜视,而肌张力低下型及其他型脑瘫容易并发外斜视;(3)在患屈光不正的脑瘫患儿中,远视为23例46眼(53.5%),近视为8例16眼(18.6%),散光为16例32眼(37.2%),屈光参差为14例28眼(32.6%);(4)脑瘫患儿VEP多表现为增幅下降,潜伏期延长,波形分化较差;其中痉挛性脑瘫VEP异常发生率高;(5)枕叶皮层受损和脑室周围白质软化(periventricular leukomalacia,PVL)伴发视觉障碍的发生率最高,PVL与枕叶皮层组发生率差别没有统计学意义(P>0.05),皮质损害脑瘫患儿无眼球震颤发生。结论:脑瘫患儿的视觉障碍在临床常见,各类型脑瘫患儿视觉障碍发生率有差别并有着不同临床特点;客观综合指标评估方法对脑瘫患儿视觉功能评估准确可靠。
AIM： To evaluate the visual impairment in cerebral palsy children with series objective indicators, and conclude their clinical features of visual function.METHODS： Objective tests including following pursuing test,optokinetic nystagmus（ OKN） drum test,refractive error examination,fundus examination,ocular deviation examination,pattern visual evoked potential（ P- VEP）tests and brain magnetic resonance imaging（ MRI） were carried out in 43 cerebral palsy children（ 86 eyes） with ocular visual dysfunction; The visual impairment data of the cerebral palsy children were collected,and the clinical features and possible mechanism were analyzed.RESULTS： 1. Of the 43 cerebral palsy children（ 86 eyes）with the visual impairment presented diversified,25（ 50 eyes,58. 1%） of refractive error,24（ 48 eyes,55. 8%） of strabismus,12（ 24 eyes,27. 9%） with nystagmus,19（ 38 eyes,44. 2 %） of optical nerve atrophy or hyperplasia,35（ 70 eyes,81. 4%） of VEP abnormality. Among children with spastic cerebral palsy, the incidence of visual impairment was statistically significant difference compared with other groups（ P 〈 0. 01）. 2. There were 16cases（ 32 eyes,37. 2%） with esotropia,6 cases（ 12 eyes,14. 0%） with exotropia and 2 cases（ 4 eyes,4. 7%） withvertical deviation. Strabismus was most common in spastic cerebral palsy children,totally 13（ 26 eyes,30.2%） w ith esotropia, and exotropia w as com m on in hypotonia and other types cerebral palsy children; 3.23（ 46 eyes,53. 5%） w ith hyperopia,8（ 16 eyes,18.6%） w ith m yopia, 16（ 32 eyes, 37. 2%） w ith astigm utism and 14 cases（ 28 eyes, 32. 6%） w ith anisom etropia; 4. Cerebral palsy children w ere usually w ith decreased VEP am plitude and prolong latency,and poor w ave form ation,m ostly in spastic cerebral palsy children; 5. Visual abnorm ality w as m ost com m on in occipital cortex dam age and periventricular leukom alacia（ PVL）. The incidence in PVL and occipital cortex had no statistically signific
出处
《国际眼科杂志》
CAS
2015年第1期174-177,共4页
International Eye Science
基金
湖南省科技厅国际合作项目基金资助(No.2012wk3012)~~
关键词
视觉障碍
脑性瘫痪
视觉诱发电位
斜视
visual impairment； cerebral palsy； visual evoked potential； strabismus
