童年时期的近视高 - 特殊考虑和安全管理

当治疗近视较高的幼儿（超过5-6D）时，重要的是考虑潜在的综合征相关性会导致眼睛猖ramp的生长。应仔细考虑眼部和全身性的潜在并发症。高度近视儿童中的速度很明显，其中38％的并发症如视网膜营养不良，造影或晶状体半脱位。¹A study on children under 10 with over 6D of myopia reported a mere 8% of the children included in this study had 'simple myopia' with no other associated ocular or systemic conditions. Over half (54%) had an underlying systemic general health condition.²The majority (89%) also had high myopia bilaterally.

亚洲男性在高近视中以绝大多数为代表，而发展延迟和极端早产与10％的近视相关。视网膜脱离是最重要的视力障碍并发症。²

视网膜l detachments in children

视网膜l detachments in children make up 3-13% of all retinal detachments³but present their own series of unique challenges as patients often are poor historians, les compliant with office examinations and difficult to manage postoperatively by the simple nature that they are children. The nature of the detachments themselves often also cause complications to be higher and prognosis to be lower as they often have a chronic condition association and macular involvement, with studies suggesting up to 97% of paediatric RRD are macula off.⁴The challenges to diagnosing them also lead to late referral further complicating successful repair.¹There is also significant risk of a following detachment in the other eye, with 90% of nontraumatic paediatric RRD having bilateral involvement or other ocular abnormalities limiting vision.¹

Retinopathy of prematurity can also cause a number of associated ocular complications, including -6.00D of myopia on average.⁷Along with retinal breaks and pigmentary vascular and pigmentary changes tractional changes and retinal detachment are common, in up to at least 26%.¹The eyes most at risk are those with avascular changes and peripheral lattice. Unfortunately even with repair, rate of failure is high and visual outcomes poor.⁸

Children with a history of intraocular surgery are also more likely to experience retinal detachment, including post congenital cataract surgery.¹What separates these detachments is they tend to occur in their twenties. The risk is poorly studied but potentially up to 51%, with bilaterality a risk. Glaucoma is also a secondary complication of these eyes, often requiring further surgical intervention to control the glaucoma.

Systemic conditions associated with childhood high myopia

Stickler syndrome指的是一组综合征，其中还包括面部外观，关节问题和听力损失。³Predominant features of Stickler syndrome, a connective tissue disorder, include nose, jaw and mouth malformations and cleft palate.¹相同的II型胶原组织障碍在玻璃体凝胶中引起异常，导致视网膜脱离，因为异常的玻璃体原纤维可以拉动视网膜。这些儿童特别冒着双边视网膜脱离的严重黄斑的风险，通常发生在生命的头十年中。^1,3通常还会有早期发作性白内障，带有楔形镜头，晶格变性和光学空玻璃体腔。

Marfan syndromeis also associated with high levels of myopia, with up to 20% of those with the condition having 7D of myopia or higher.⁵宽叶（透镜脱位 /半脱位）更为常见，最高为80％，通常是最初的呈现特征。那些近视和倾斜异端的人也更有可能拥有视网膜超脱，尤其是生命的早期（20多岁）。由于瞳孔扩张和晶状体异常，手术维修可能特别复杂，并且双侧疾病的风险很高。

Homocystinuria通常，近视较高和晶状体的诊断（平均年龄为11.4岁）延迟诊断（平均年龄11.4岁）。⁶它是酶的遗传缺乏，如果不存在，则会导致化学同型半胱氨酸组织中积累。当不管理时，它会导致血栓栓塞，冠状动脉疾病和脑血管疾病。维生素或饮食限制是可能的，但是由于疾病的稀有性和获取样品的困难，诊断通常会延迟。不幸的是，即使治疗眼部并发症，全晶状体共脱位，视网膜脱离和视力差的特征仍然存在。⁶

The authors of the paper “Associations of high myopia in childhood” discuss the lack of a systemic approach to identifying syndromic associations in children with high myopia. They suggested referral to general paediatrics and/or paediatric ophthalmology to be appropriate for all children under 10, with 6D of myopia or higher due to the high proportion of associated conditions. Another potential rule of thumb is to be suspicious when the degree of myopia is more than a child’s age. This, along with careful inspection of all ocular elements is crucial to identifying complications. Retinal examination through dilated pupils, thorough history taking and communication with a child’s health professional team are all crucial to identifying children at risk. Challengingly, often there is no reliable clue, symptom or family history to identify the sinister causes, soconsider 'simple myopia' a diagnosis of exclusion in children under 10 with high myopia。²