视盘倾斜综合征的视盘及屈光状态观察

Optic disc and refractive status in patients with tilted disc syndrome

目的对视盘倾斜综合征(TDS)患者其视盘及对应屈光状态进行观察。方法回顾性研究.统计2018年1月至2018年12月期间于我院门诊就诊患儿中符合视盘倾斜综合征诊断者16例(30只眼),其中男性9例,女性7例,给予免散瞳眼底照相、散瞳检影验光检查,测量其视盘倾斜率(视盘短轴/视盘长轴)、视盘相对大小值(平均视盘直径/视盘至黄斑距离);统计其屈光分布情况。结果16例(30只眼)患儿中TDS伴随弧形斑7例(占43.8%);伴随血管反向9例(占56.3%)。视盘向颞下方倾斜9例(占56.3%),向下方倾斜2例(占12.5%),向上方倾斜1例(占6.25%),向颞上方倾斜4例(占25%)。以向颞下方倾斜常见。视盘倾斜率(30只眼)波动在0.5~0.9范围内,其中严重倾斜23只眼,占76.7%;视盘相对大小值波动在0.24~0.47范围内,其中视盘相对大小值<1:3者有9只眼,提示视神经发育不良。16例患儿中屈光度分布情况为:伴随散光者(散光度数>0.50D)12例(占75%);伴随近视者15例(占93.7%);其中1例为单纯性散光。以近视散光居多,角膜散光大于总散光。所有患儿在散瞳客观检影验光下矫正视力均能达到0.8及以上。近视度数与视盘倾斜率具有正相关性,视盘倾斜越明显,近视度数越高(r=0.485,P=0.007),具有统计学意义;而散光度数绝对值与视盘倾斜率的相关性无统计学意义(P>0.05)。视盘相对大小与近视度数及散光度数无明显相关性(P>0.05)。结论TDS患儿常伴有屈光的异常,我们临床上需要认真鉴别,避免漏诊或误诊。

Objective To assess the optic disc and refractive status in patients with tilted disc syndrome(TDS).Methods We conducted a retrospective analysis of 16 patients(9 males, 7 females;30 eyes) with TDS who presented to our out-patient clinic from January 2018 to December 2018. Non-cycloplegic fundus imaging examination and cycloplegic optometry were performed. The disc tilt ratio(the shortest diameter/the longest diameter) and the relative disc size(mean optic disc diameter/optic disc to macular distance) were also measured and refractive status were analyzed. Results Of all 16 patients(30 eyes), TDS was associated with crescent in 7 cases(43.8%), with reverse vascular in 9 cases(56.3%). The optic disc tilted to the inferior temporal quadrant in 9 cases(56.3%), to the inferior quadrant in 2 cases(12.5%), to the superior temporal quadrant in 1 case(6.25%) and to the superior temporal quadrant in 4 cases(25%). The disc tilt ratio(30 eyes) ranged from 0.5 to 0.9, among which 23 eyes(76.7%) were severely tilted. The relative disc size ranged from 0.24 to 0.47, among which 9 eyes had a relative disc size of less than 1:3, indicating optic nerve dysplasia. The refraction distribution in the 16 patients were as follows: 12 cases(75%) with astigmatism(>0.50 D, including 1 case with simple astigmatism), and 15 cases(93.7%) with myopia. Myopic astigmatism was more commonly seen, and corneal astigmatism was larger than the total astigmatism. The best corrected visual acuity of all children was 0.8 or above under cycloplegic optometry. There was a positive correlation between the degree of myopia and the disc tilt ratio. The more tilt the optic disc was, the higher the degree of myopia was(r=0.485,P=0.007), which was statistically significant. There was no significant association between astigmatism and optic disc tilt(P>0.05), and the relative disc size was also not associated with myopia or astigmatism(P>0.05). Conclusions Children with TDS are often accompanied by refractive abnormalities. Careful assessment in clinical practice is needed to avoid missed diagnosis or misdiagnosis.