儿童功能性视觉障碍24例临床分析

目的：:探讨儿童功能性视觉障碍的临床特征、发病原因以及治疗和预后情况。方法：:回顾性系列病例研究。选择2014年10月至2019年10月就诊于徐州复兴眼科医院确诊为功能性视觉障碍的儿童患者24例。收集患者的年龄、性别、发病时间、睫状肌麻痹后验光度数和视力、视野、色觉以及调节灵活度检查等资料，分析引起功能性视觉障碍的社会...

Clinical Analysis of 24 Children with Functional Vision Loss

Objective: To investigate the clinical characteristics, pathogenesis, treatment and prognosis conditions of children with functional vision loss (FVL). Methods: In this retrospective series case study, 24 children who were diagnosed with functional vision loss in Xuzhou Fuxing Ophthalmology Hospital from October 2014 to October 2019 were analyzed retrospectively. Data on age, color vision and accommodative facility of the patients and other factors were collected and analyzed. The data were analyzed by t-test. Results: Of the 24 patients selected, 4 were males and 20 were females, with an average age of 9.8±2.0 years. The onset time was less than 1 month in 9 cases (37%), 2-6 months in 10 cases (42%), and more than 6 monthsin 5 cases (21%). The visual acuity of both eyes decreased in varying degrees by an average of 0.39±0.22 in the right eye and 0.40±0.23 in the left eye. There was no significant difference between the left and right eyes (t=-0.065, P=0.949). Blurred vision was the most common complaint in 20 cases (83%). There were 21 cases (87%) with abnormal visual fields, including 8 patients (33%) with irregular defects in the periphery; 8 patients (33%) with concentric reduction; 5 patients (21%) with the entire visual field involved in visual field defects; and only 3 patients (13%) had no significant abnormalities. Accommodative facility was abnormal in 24 cases (100%). Among the psychosocial inducing factors which cause functional vision loss, academic pressure accounted for the highest proportion in 8 cases (33%), followed by interpersonal (classmate) relationship conflicts in 5 cases (21%), family and marriage factors in 4 cases (17%), and wanting to wear glasses in 3 cases (13%), and 4 unknown causes (16%). Refractive correction, reassurance and suggestive therapy were given for treatment. Prognosis was good, 58% of the patients recovered within 1 month and 91% within 1 year. Conclusions: Blurred vision is the most common complaint of functional vision loss in children. Visual field examination has its special manifestation, and color vision and accommodation are mostly abnormal. Academic pressure and interpersonal (classmate) tensions are common psychosocial-inducing factors. Most patients with FVL improve with reassurance and suggestions, and have a good prognosis.