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新型预矫正器:英国一项手持激光器继发儿童视网膜损伤的大型病例系列研究

Naz Raoof and Patrick Bradley and Maria Theodorou and Anthony T. Moore and Michel Michaelides",

期刊名称:American Journal of Ophthalmology

卷期:2016年第171卷

摘要

目的:旨在描述一项大型单中心研究手持激光器继发儿童视网膜损伤的特点,重点是潜在的预后因素。设计:回顾病例研究。方法:从我们的患者电子病历系统中确定了16例手持激光器继发视网膜损伤儿童(24只眼)。对病历记录,数字眼底摄影和光谱域光学相干断层扫描图像进行了回顾。结果:受累儿童平均年龄12.7岁(9-16岁),12名男性和4名女性。平均随访时间为5.4个月(1-23个月)。5例儿童(31%)怀疑有视网膜营养不良。就诊时平均logMAR视敏度为0.3020/40)(-0.20 [20 / 12.5]1.6 [20/800])。 11例儿童(69; 15只眼)具有“轻度”损伤,限于感光器和椭圆体层的局灶性视网膜破裂;这种损伤预后较佳,平均视力为0.1020/25)。2例儿童的3只眼为“中度”损伤,视网膜破裂,限于视网膜外层,但实际上弥漫性而非局灶性。3例患者(4只眼)为“严重”损伤,有中央凹下外层视网膜结构缺失,内层视网膜层覆有高反射物质。结论:手持激光设备继发视网膜损伤可能难以诊断,并且很可能报告不足。这些数据在公共领域非常重要,因此监管当局应认识到激光视网膜病变可能是儿童视力损害可避免的一种原因,并采取措施以减少激光损伤的发生率和影响。

Purpose To characterize a large single-center series of retinal injuries in children secondary to handheld laser devices, with emphasis on potential prognostic factors. Design Retrospective case series. Methods Sixteen children (24 eyes) with retinal injuries secondary to handheld lasers were identified from our electronic patient record system. Case notes, digital fundus photography, and spectral-domain optical coherence tomography images were reviewed. Results The mean age of affected children was 12.7 years (range 9–16 years), with 12 male and 4 female subjects. Mean follow up was 5.4 months (range 1–23 months). Five children (31%) were referred as suspected retinal dystrophies. The mean logMAR visual acuity at presentation was 0.30 (20/40) (range −0.20 [20/12.5] to 1.6 [20/800]). Eleven children (69%; 15 eyes) had “mild” injuries with focal retinal disruption confined to the photoreceptor and  ellipsoid layers; such injuries were associated with a better prognosis, the mean visual acuity at presentation being 0.10 (20/25). “Moderate” injuries were seen in 3 eyes of 2 children, with retinal disruption confined to the outer retinal layer but diffuse rather than focal in nature. Three patients (4 eyes) had “severe” injuries, with subfoveal outer retinal architecture loss and overlying hyperreflective material in inner retinal layers. Conclusion Retinal injuries secondary to handheld laser devices may be difficult to diagnose and are likely underreported. It is important that such data are in the public domain, so regulatory authorities recognize the importance of laser retinopathy as an avoidable cause of childhood visual impairment and take steps to minimize the incidence and impact of laser injuries. "


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