儿童功能性视觉障碍24例临床分析

doi:10.3760/cma.j.cn115909-20201223-00493

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摘要目的：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心理诱因、治疗以及预后情况。数据采用t检验进行分析。结果：24例功能性视觉障碍患者中男4例，女20例，年龄（9.8±2.0）岁。发病时间在1个月以内9例（37%），2～6个月10例（42%），大于6个月的5例（21%）。双眼最佳矫正视力均见不同程度下降，右眼0.39±0.22，左眼0.40±0.23，差异无统计学意义（t=-0.065，P=0.949）。20例（83%）以视力模糊为主诉。视野有异常的患者21例（87%），其中表现为周边不规则缺损8例（33%），向心性缩小8例（33%），中心和周边视野均累及5例（21%）；仅3例（13%）未见明显视野异常。调节灵活度异常24例（100%）。引起功能性视觉障碍的社会心理因素方面：学业压力大所占比例最高有8例（33%），其次是在人际（同学）关系矛盾方面5例（21%），家庭婚姻因素4例（17%），存在想戴眼镜心理3例（13%），另有其他原因4例（16%）。治疗上给予屈光矫正、心理安抚和暗示治疗，最终预后良好，58%患者在1个月内恢复，91%患者于1年内恢复。结论：儿童功能性视觉障碍以视力问题为最常见主诉，视野检查有其特殊的表现形式，色觉和调节功能多有异常，以学业压力大和人际（同学）关系矛盾为常见的社会心理因素，治疗以心理安抚和暗示为主，大部分患者预后较好。

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关键词 ： , 功能性视觉障碍, 情绪, 转换障碍, 儿童

Abstract： 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 months in 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.

Key words： functional visual loss emotion conversion disorder children

收稿日期: 2020-12-23

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通讯作者: 施维（ORCID：0000-0002-5353-9005），Email：weishi1666@163.com

引用本文:

郭长锋1 袁东坡1 马欣欣1 倪茹1 施维2. 儿童功能性视觉障碍24例临床分析[J]. 中华眼视光学与视觉科学杂志, 2021, 23(7): 528-533. Changfeng Guo1,Dongpo Yuan1,Xinxin Ma1,Ru Ni1,Wei Shi2. Clinical Analysis of 24 Children with Functional Vision Loss. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(7): 528-533. DOI: 10.3760/cma.j.cn115909-20201223-00493

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20201223-00493 或 https://www.cjoovs.com/CN/Y2021/V23/I7/528

[1]	Balen A, Slijper F. Psychogenic amblyopia in children. Pediatric Ophthalmology & Strabismus, 1978, 15(3): 164-167. DOI: 10.3928/0191-3913-19780501-11.
[2]	Graham B, John R, Janis I. streff syndrome. J Opt Vis Dev, 1994, 25(2): 64-69.
[3]	Santos-Bueso E, Zarco-Villarosa D, Esteban-De-Antonio M, et al. Non-organic visual loss. Arch Soc Esp Oftalmol, 2014, 89(7): 257-259. DOI: 10.1016/j.oftal e.2014.08.001.
[4]	俞自萍. 色盲检查图. 5版. 北京: 人民卫生出版社, 1996.
[5]	Shing E, Prasad A, Li B, et al. Ophthalmic findings in pediatric conversion disorder. Ophthal Vis Neuro, 2018, 3(1): 1-4.
[6]	Muñoz-Hernández AM, Santos-Bueso E, Sáenz-Francés F, et al. Nonorganic visual loss and associated psychopathology in children. Eur J Ophthalmol, 2012, 22(2): 269-273. DOI: 10.5301/EJO.2011.8378.
[7]	Somers A, Casteels K, Van Roie E, et al. Non-organic visual loss in children: prospective and retrosp ective analysis of associated psychosocial problems and stress factors. Acta Ophthalmol, 2016, 94(5): e312-316. DOI: 10.1111/aos.12848.
[8]	Bruce BB, Newman NJ. Functional visual loss. Neurol Clin, 2010, 28(3): 789-802. DOI: 10.1016/j.ncl.2010.03.012.
[9]	Zinkernagel SM, Mojon DS. Distance doubling visual acuity test: A reliable test for nonorganic visual loss. Graefes Arch Clin Exp Ophthalmol, 2009, 247(6): 855-858. DOI: 10.1007/s00417- 008-1019-9.
[10]	Liu G, Volpe N, Galetta S. Functional (Nonorganic) Visual Loss, 2019: 379-393.
[11]	Sitko KR, Peragallo JH, Bidot S, et al. Pitfalls in the useof stereoacuity in the diagnosis of nonorganic visual loss. Ophthalmology, 2016, 123(1): 198-202. DOI: 10.1016/ j.ophtha.2015.09.024.
[12]	Mafi M. Unexplained visual Loss; Different etiologies, costs and diagnostic guideline proposal. Med Surg Ophthal Res, 2019, 2(5): 1-7. DOI: 10.31031/msor.2019.02.000549.
[13]	Frisén L. Identification of functional visual field loss by automated static perimetry. Acta Ophthalmol, 2014, 92(8): 805- 809. DOI: 10.1111/aos.12405.
[14]	Schoenfeld MA, Hassa T, Hopf JM, et al. Neural correlates of hysterical blindness. Cereb Cortex, 2011, 21(10): 2394-2398. DOI: 10.1093/cercor/bhr026.
[15]	常枫, 陈云辉, 陈晓, 等. 调节异常所致视力下降的临床分析. 中华眼视光学与视觉科学杂志, 2018, 20(9): 541-545. DOI: 10.3760/cma.j.issn.1674-845X.2018.09.006.
[16]	王华德, 张清生, 沈兰, 等. 儿童非弱视性功能性视力低下的原因分析. 中华眼视光学与视觉科学杂志, 2019, 21(12): 937- 941. DOI: 10.3760/cma.j.issn.1674-845X.2019.12.010.
[17]	Hyndman J. Spasm of the near reflex: Literature review and proposed management strategy. Binocul Vis Ocul Motil, 2018, 68(3): 78-86. DOI: 10.1080/2576117X.2018.1486680.
[18]	Nguyen HTT, Hoang TT, Tran AP, et al. Combined interventions for nonorganic visual loss in a case with pseudo-myopia: A perspective from vietnam. Case Rep Ophthalmol, 2020, 11(2): 229-233. DOI: 10.1159/000508236.
[19]	Lv X, Chen Y, Tan W, et al. Functional neuroanatomy of the human accommodation response to an “E” target varying from -3 to -6 Diopters. Front Integr Neurosci, 2020, 14(29): 1-11. DOI: 10.3389/fnint.2020.00029.
[20]	Stevens FL, Hurley RA, Taber KH. Anterior cingulate cortex: Unique role in cognition and emotion. J Neuropsychiatry Clin Neurosci, 2011, 23(2): 121-125. DOI: 10.1176/jnp.23.2.jnp121.
[21]	Lim SA, Siatkowski RM, Farris BK. Functional visual loss in adults and children patient characteristics, management, and outcomes. Ophthalmology, 2005, 112(10): 1821-1828. DOI: 10.1016/j.ophtha.2005.05.009.
[22]	Broderick KM, Ableman TB, Weber ED, et al. Non-organic vision loss in the Afghanistan and Iraq conflicts. Neuroophthalmology, 2017, 41(4): 175-181. DOI: 10.1080/01658107.2017.1295998.
[23]	Taich A, Crowe S, Kosmorsky GS, et al. Prevalence of psychosocial disturbances in children with no norganic visual loss. J AAPOS, 2004, 8(5): 457-461. DOI: 10.1016/ j.jaapos.2004.06.006.
[24]	Gittinger JW. Diagnosis and management of medically unexplained visual loss; One clinician's pers pective. Surv Ophthalmol, 2020, S0039-6257(20): 30177-30186. DOI: 10.1016/j.survophthal.2020.12.005.
[25]	Kini A, Ajjeya MT, Sudhakar P. Nonorganic vision loss. European Ophthalmic Review, 2020, 14(1): 26-33 DOI: 10.17925/EOR.2020.14.1.26.
[26]	刘波, 杨于力, 王刚. 二种暗示方式治疗癔症性视力下降的疗效比较. 中华眼视光学与视觉科学杂志, 2017, 19(7): 402-405. DOI: 10.3760/cma.j.issn.1674-845X.2017.07.004.
[27]	Lee SH, Shin KS, Lee YH. The clinical features and the prognosis of functional visual loss in children. J Korean Ophthalmol Soc, 2016, 57(9): 1435-1440. DOI: 10.3341/jkos.2016.57.9.1435.