Abstract：
BACKGROUND: Infantile nystagmus syndrome can be associated with an afferent problem (anterior or posterior segment) or constitute an isolated idiopathic disorder. With a normal ophthalmic examination, current guidelines recommend electroretinography (ERG) rather than magnetic resonance (MRI) for preliminary workup. Given the limited use of optical coherence tomography (OCT) in preverbal children, the purpose of this study was to evaluate the role of handheld OCT (HH-OCT) in the initial diagnostic evaluation of infantile nystagmus.
METHODS: In this cross-sectional case series, the medical records of all children with infantile nystagmus and HH-OCT imaging at the Duke Eye Center from August 2016 to July 2021 were retrospectively reviewed. Children with anterior segment disorders or obvious retina/optic nerve structural pathology, bilateral ophthalmoplegia, or Down syndrome were excluded. Two masked pediatric ophthalmologists graded HH-OCT images for optic nerve head and macular abnormalities. A neuro-ophthalmologist reviewed clinical findings of each patient\'s presenting visit and recommended appropriate testing (MRI vs ERG), initially without, and again with HH-OCT image review.
RESULTS: A total of 39 cases were included, with mean presenting age of 1.3 years. Final diagnoses included retinal or foveal abnormalities (7), optic nerve pathology (13), idiopathic (10), or unknown (9). HH-OCT findings included optic nerve hypoplasia (1), optic nerve elevation (3), persistence of the inner layers at the fovea (9), thin ganglion cell layer (8), ellipsoid zone abnormality (3), and thin choroid (1). HH-OCT findings altered initial clinical-only management in 16 cases (41%), including avoiding MRI (5) and ERG (10) testing.
CONCLUSIONS: Our results suggest that HH-OCT has the potential to augment and streamline the evaluation of infantile nystagmus.
METHODS: In this cross-sectional case series, the medical records of all children with infantile nystagmus and HH-OCT imaging at the Duke Eye Center from August 2016 to July 2021 were retrospectively reviewed. Children with anterior segment disorders or obvious retina/optic nerve structural pathology, bilateral ophthalmoplegia, or Down syndrome were excluded. Two masked pediatric ophthalmologists graded HH-OCT images for optic nerve head and macular abnormalities. A neuro-ophthalmologist reviewed clinical findings of each patient\'s presenting visit and recommended appropriate testing (MRI vs ERG), initially without, and again with HH-OCT image review.
RESULTS: A total of 39 cases were included, with mean presenting age of 1.3 years. Final diagnoses included retinal or foveal abnormalities (7), optic nerve pathology (13), idiopathic (10), or unknown (9). HH-OCT findings included optic nerve hypoplasia (1), optic nerve elevation (3), persistence of the inner layers at the fovea (9), thin ganglion cell layer (8), ellipsoid zone abnormality (3), and thin choroid (1). HH-OCT findings altered initial clinical-only management in 16 cases (41%), including avoiding MRI (5) and ERG (10) testing.
CONCLUSIONS: Our results suggest that HH-OCT has the potential to augment and streamline the evaluation of infantile nystagmus.
摘要：
背景：婴儿眼震综合征可与传入问题（前段或后段）相关，或构成孤立的特发性疾病。通过正常的眼科检查，目前的指南建议视网膜电图(ERG)而不是磁共振(MRI)进行初步检查.鉴于光学相干断层扫描（OCT）在言语前儿童中的使用有限，本研究的目的是评估手持式OCT(HH-OCT)在婴儿眼球震颤初步诊断评估中的作用.
方法：在这个横截面案例系列中，我们对2016年8月至2021年7月在杜克大学眼科中心进行的所有婴儿眼球震颤和HH-OCT影像检查的病历进行了回顾性分析.儿童眼前段疾病或明显的视网膜/视神经结构病变，双侧眼肌麻痹，或唐氏综合征被排除。两名蒙面小儿眼科医生对视神经乳头和黄斑异常的HH-OCT图像进行分级。神经眼科医生回顾了每位患者就诊的临床发现，并推荐了适当的测试（MRI与ERG），最初没有，并再次行HH-OCT图像检讨。
结果：共39例，平均年龄为1.3岁。最终诊断包括视网膜或中央凹异常（7），视神经病理学(13)，特发性（10），或未知（9）。HH-OCT检查结果包括视神经发育不全(1),视神经抬高（3），中央凹内层的持久性（9），薄神经节细胞层（8），椭球区异常(3),和细脉络膜（1）。HH-OCT结果改变了16例（41%）的初始临床治疗，包括避免MRI（5）和ERG（10）测试。
结论：我们的研究结果表明，HH-OCT具有增强和简化婴儿眼球震颤评估的潜力。
方法：在这个横截面案例系列中，我们对2016年8月至2021年7月在杜克大学眼科中心进行的所有婴儿眼球震颤和HH-OCT影像检查的病历进行了回顾性分析.儿童眼前段疾病或明显的视网膜/视神经结构病变，双侧眼肌麻痹，或唐氏综合征被排除。两名蒙面小儿眼科医生对视神经乳头和黄斑异常的HH-OCT图像进行分级。神经眼科医生回顾了每位患者就诊的临床发现，并推荐了适当的测试（MRI与ERG），最初没有，并再次行HH-OCT图像检讨。
结果：共39例，平均年龄为1.3岁。最终诊断包括视网膜或中央凹异常（7），视神经病理学(13)，特发性（10），或未知（9）。HH-OCT检查结果包括视神经发育不全(1),视神经抬高（3），中央凹内层的持久性（9），薄神经节细胞层（8），椭球区异常(3),和细脉络膜（1）。HH-OCT结果改变了16例（41%）的初始临床治疗，包括避免MRI（5）和ERG（10）测试。
结论：我们的研究结果表明，HH-OCT具有增强和简化婴儿眼球震颤评估的潜力。
