■患有自闭症谱系障碍(ASD)的儿童可能由于高屈光不正和对眼镜或隐形眼镜的厌恶而导致视力受损。视觉模糊是近视眼造成的,远视,或散光在一只或两只眼睛。屈光手术可以恢复锐利的视力,消除对眼镜和隐形眼镜的需要。锐利视力的恢复可以改善ASD行为。我们旨在通过使用家长代理报告,使用眼科测量以及屈光手术后的行为和学校表现改变来确定该队列的屈光结局。
■这次介入,回顾性病例系列包括来自267例屈光不正和神经发育障碍(NDDs)患儿的数据,这些患儿在15年内被诊断为单纯ASD或有ASD样行为的NDD.采用了三种屈光手术方法之一,选择独特的方法为孩子的眼睛解剖量身定制。对131名儿童进行了激光屈光性角膜切除术(PRK),在115名儿童中植入有晶状体眼人工晶状体(pIOL),摘除晶状体和植入人工晶状体(折射晶状体交换,RLE)在21个孩子中。所有手术都在短暂的全身麻醉下进行,孩子在同一天回家。
■手术年龄中位数为10.9岁,中位随访期为3.1年。术前屈光不正范围为平均值(标准偏差)7.5(0.09)D至-14.3(4.8)D。手术将87%的儿童校正为正常焦距(±1D)。视力提高了平均0.6对数的最小分辨率角,相当于标准视力表上的6条线。在每个亚组中,基线和最近的随访检查之间的视力变化显着(均P<0.01)。在每个亚组中,基线和每次随访之间,在术后3、12、24、36、60和>60个月时,球面等效屈光不正的变化是显着的(所有P<0.01)。72%(192)接受治疗的儿童的社交互动和ASD行为有所改善(P<0.01)。威胁视力的并发症发生率低。
■屈光手术改善了大多数ASD和严重近视儿童的视觉功能和行为,远视,或散光。PRK,pIOL,和RLE手术似乎是改善屈光不正的有效和合理安全的方法,视敏度,许多患有ASD和ASD样NDD的屈光不正儿童的行为。
UNASSIGNED: Children with autism spectrum disorder (ASD) may have impaired vision owing to high refractive errors and aversion to spectacles or contact lenses. Visual blurring is caused by near-sighted myopia, far-sighted
hyperopia, or astigmatism in one or both eyes. Refractive surgery can restore sharp vision and eliminate the need for spectacles and contact lenses. Restoration of sharp vision may improve ASD behavior. We aimed to determine the refractive outcomes in this cohort using ophthalmic measures and behavioral and school performance alterations after refractive surgery by employing parent-proxy reports.
UNASSIGNED: This interventional, retrospective case series included data from 267 children with refractive errors and neurodevelopmental disorders (NDDs) diagnosed as ASD alone or NDD with ASD-like behaviors over a 15-year period. One of three refractive surgery methods was employed, with the choice of method uniquely tailored to the child\'s eye anatomy. Laser photorefractive keratectomy (PRK) was performed in 131 children, implantation of a phakic intraocular lens (pIOL) in 115 children, and removal of the crystalline lens and implantation of an intraocular lens (refractive lens exchange, RLE) in 21 children. All procedures were performed under brief general anesthesia, with the child returning home on the same day.
UNASSIGNED: The median age at surgery was 10.9 years and the median follow-up period was 3.1 years. Pre-operative refractive errors ranged from a mean (standard deviation) +7.5 (0.09) D to -14.3 (4.8) D. Surgery corrected 87% of the children to normal focal length (± 1 D). Visual acuity improved an average of 0.6 logarithm of the minimum angle of resolution, the equivalent of 6 lines on a standard eye chart. Change in visual acuity was significant (all P < 0.01) between baseline and the most recent follow-up examination in each of subgroups. Change in spherical equivalent refractive error at 3, 12, 24, 36, 60, and > 60 months post-operatively were significant (all P < 0.01) between baseline and each follow-up visit in each of subgroups. Social interactions and ASD behaviors improved in 72% (192) of the treated children (P < 0.01). The incidence of sight-threatening complications was low.
UNASSIGNED: Refractive surgery improves both visual function and behavior in most children with ASD and major myopia,
hyperopia, or astigmatism. The PRK, pIOL, and RLE procedures appear to be effective and reasonably safe methods for improving refractive error, visual acuity, and behavior in many ametropic children with ASD and ASD-like NDDs.