儿童自发性视盘周围视网膜下出血18例

Spontaneous peripapillary subretinal hemorrhage in 18 children

目的总结18例儿童自发性视盘周围视网膜下出血的临床特征。设计回顾性病例系列。研究对象 2017年7-8月于北京同仁验光配镜中心因近视就诊行彩色眼底照相诊断视盘周围视网膜下出血的儿童18例(18眼),患者年龄9~16岁,平均(12.8±1.9)岁;男性11例(61.1%)。方法对18例视盘周围视网膜下出血患者的临床资料进行回顾性分析,包括患者一般资料和屈光度、视力、彩色眼底照相等检查数据,并对视盘部分参数进行测量。并与同期就诊的同年龄儿童对照。主要指标出血位置、形态以及视盘形态。结果所有患者均为近视,出血眼平均屈光度为(-3.42±1.54)D(范围:-6.25 D^-0.63 D),对侧眼平均屈光度为(-3.57±1.93)D(范围:-8.00 D^0.00 D),二者差异无统计学意义(P=0.39)。18例患者均为单眼发病,视网膜下出血界限清楚,呈新月形或类圆形,均位于视盘鼻侧和鼻下方。鼻侧盘沿隆起,边界模糊,视盘小且拥挤,呈小视杯或视杯缺失。18眼均具有视盘旁颞侧萎缩弧。对侧眼与出血眼相比具有相似的视盘形态。出血眼视盘倾斜指数为1.43±0.19,对侧眼倾斜指数为1.38±0.22,二者差异无统计学意义(P=0.23),但明显高于同期就诊的18例对照组儿童1.23±0.08(P=0.00)。结论本文总结了一种发生在儿童的视盘周围视网膜下出血的临床特征,患者均为近视,出血主要位于视盘鼻侧,界限清楚,具有视盘倾斜、视杯拥挤等特征。

Objective To summarize the clinical characteristics of spontaneous peripapillary subretinal hemorrhage (PSH) in 18 children. Design Retrospective case series. Participants 18 patients (18 eyes) with peripapillary subretinal hemorrhage from Tongren Eye Care Center from July to August 2017 were included. The age of the participants ranged from 9~16 years (mean 12.8±1.9 years). 11 cases were boys (61.1%) and 7 cases were girls (38.9%). Methods We reviewed the clinical data including the refractive error, visual acuity and color fundus examination, and some parameters of optic disc were measured. Main Outcome Measures The location, the morphology of the hemorrhage and optic disc. Results All the participants were myopic. Mean spherical equivalent (SE) was -3.42±1.54 D (range:-6.25 D^-0.63 D) in PSH eyes, and -3.57±1.93 D (range:-8.00D^0.00 D) in fellow eyes (P=0.39). All children had isolated, monocular, nasal or inferionasal peripapillary subretinal hemorrhage, a crowded-tilted optic disc and parapapillary atrophy. Optic ovality was 1.43±0.19 in PSH eyes, and 1.38±0.22 in fellow eyes which was not significantly different, but higher than the control group (1.23±0.08, P<0.01). Conclusion We summarized the clinical characteristics of peripapillary subretinal hemorrhages in children. All the patients were myopic and the hemorrhages primarily occured at nasal and appeared oval shape. PSH patients have the typical fundus characteristic of myopia, such as tilted optic disc and elevated nasal edge.