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393例儿童视网膜脱离的原发疾病及其分布的临床特征

Primary Diseases of 393 Cases of Pediatric Retinal Detachment and the Distribution of Clinical Characteristics

    摘要
  • 摘要:
      目的   研究儿童视网膜脱离的原发疾病以及其分布的临床特点。
      方法   回顾性分析从2015年1月−2020年12月因视网膜脱离而就诊于四川大学华西医院且年龄小于15岁患者的病历资料。记录患者的年龄、性别、病史、视网膜脱离范围以及预后。
      结果   在纳入的393例（464只眼）儿童视网膜脱离患者中，男性261例（312只眼），女性132例（152只眼），男女比例为1.98∶1。儿童视网膜脱离最常见的原发疾病为眼部发育异常（57.8%，227例），其次为眼外伤（19.8%，78例）和近视（14.2%，56例）。婴幼儿期、学龄前期视网膜脱离主要的原发疾病为眼部发育异常，比例分别81.8%（126例）、55.8%（43例）；学龄期的主要原发疾病为眼部发育异常（35.8%，58例）、近视（30.2%，49例）和眼外伤（26.5%，43例）。儿童视网膜脱离最常见的类型为孔源性视网膜脱离（46.8%，184例），其中眼外伤（37.5%，69/184）和近视（30.4%，56/184）是其常见的两种原发疾病；其次为牵拉性视网膜脱离（43.3%，170例），其中家族性渗出性玻璃体视网膜病变（familial exudative vitreoretinopathy, FEVER）占47.6%（81/170），为常见原发疾病；渗出性视网膜病变最少见（9.9%，39例），其中Coats病占71.8%（28/39）为常见原发疾病。与牵拉性全视网膜脱离相比，孔源性全视网膜脱离的首次术后效果较佳（|Z|=3.026，P=0.002）。儿童孔源性视网膜脱离，裂孔常见的位置为颞侧。原发疾病为眼外伤的视网膜脱离最常见的裂孔为视网膜撕裂孔，其次为锯齿缘离断；近视所导致的孔源性视网膜脱离其裂孔最常见的位置为变性区的圆孔。
      结论   在本研究中视网膜脱离患者男生人数多于女生，眼部发育异常、眼外伤、近视是儿童视网膜脱离的主要原发疾病。应根据不同的年龄段，开展不同的宣传教育。

     

    Abstract:
      Objective   To investigate the primary diseases and the distribution of the clinical characteristics of pediatric retinal detachment.
      Methods   Clinical records of patients aged 0-14 years old who had retinal detachment and who were hospitalized at the Department of Ophthalmology, West China Hospital, Sichuan University between January 2015 and December 2020, were retrospectively analyzed. The information on the demographic data, history, the scope of retinal detachment, and prognosis was retrieved and documented.
      Results   A total of 464 eyes of 393 patients were included in this study, including 261 male and 132 female patients at a ratio of 1.98:1. The most common type of primary disease causing pediatric retinal detachments was associated with ocular dysplasia (227 cases, 57.8%), followed by trauma (78 cases, 19.8%) and myopia (56 cases, 14.2%). For infants and preschool children, the primary disease was predominantly ocular dysplasia at a rate of 81.8% (126 cases) and 55.8% (43 cases), respectively. For school-age children, in addition to ocular dysplasia (58 cases, 35.8%), myopia (49 cases, 30.2%) and ocular trauma (43 cases, 26.5%) also accounted for a large proportion of the primary diseases. The most common type of pediatric retinal detachment was rhegmatogenous retinal detachment (184 cases, 46.8%), and ocular trauma and myopia were the most common primary diseases, accounting for 37.5% (69/184) and 30.4% (56/184), respectively. 170 patients were diagnosed with traction retinal detachment, the second most common type of pediatric retinal detachment, and familial exudative vitreoretinopathy (FEVER) was the main primary disease, accounting for 47.6% (81/170). Exudative retinal detachment (39 cases, 9.9%) was the least common type of pediatric retinal detachment. Coats disease was the main primary disease causing exudative retinal detachment, accounting for 71.8% (28/39). After the first repair surgery, patients who had complete traction retinal detachment generally had poorer anatomical outcomes compared with those with complete rhegmatogenous retinal detachments (|Z|=3.026, P=0.002). The retinal break was most commonly seen on the temporal side in pediatric rhegmatogenous retinal detachments. In the retinal detachments caused by trauma, the most common type of retinal break was retinal tear, followed by ora serrata dialysis. Myopic rhegmatogenous retinal detachments were most commonly found in the round holes in lattice degeneration region.
      Conclusion   In the current study, boys were found to be more susceptible to retinal detachment than girls did. Ocular dysplasia, ocular trauma and myopia were major etiologic factors for pediatric retinal detachment. Appropriate information and education measures should be emphasized for different age groups.

     

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