www.ksmf.org/arhimed   arhimed@ksmf.org   [5/10/2025 12:42:36 PM] http://www.ksmf.org/arhimed/poglej.asp?id=23 Elektrofiziološka ocena vidne poti pri šolskih otrocih Avtor: Manca Tekavcic-Pompe Mentor: dr. Jelka Brecelj, znanstvena sodelavka Somentor: dr. Branka Stirn-Kranjc, dr.med. IZHODIŠCA: Opticni nevritis otrok je trd diagnosticni oreh, saj se od klasicnega opticnega nevritisa odraslih razlikuje po atipicni klinicni sliki, pa tudi po izvidih nekaterih preiskav. Tudi objektivnost preiskav, kot so pregled vidnega polja, test po Haitzu in test kontrastne senzitivnosti, je pri otrocih manjša kot pri odraslih. NAMEN: Najobjektivnejše v diagnostiki opticnega nevritisa odraslih so elektrofiziološke preiskave. Zanimalo nas je ali so te preiskave dovolj objektivne tudi pri otrocih. Napravljena je bila prospektivna študija, ki je zajela otroke (14), ki so bili v zadnjih dveh letih s sumom na opticni nevritis napoteni na Ocesno kliniko v Ljubljani. METODE: Pri vseh smo najprej napravili oftalmološki status, pregled vidnega polja, test po Haitzu in test kontrastne senzitivnosti, nato pa se elektrofiziološke preiskave: bliskovno in slikovno elektroretinografijo (ERG) ter vidne evocirane potenciale (VEP). Rezultate preiskav smo primerjali z rezultati skupine 14 zdravih prostovoljcev enake povprecne starosti in skupine štirih otrok s potrjeno diagnozo multiple skleroze. REZULTATI: Ugotovili smo, da so merila, na podlagi katerih oftalmologi pri otroku posumijo na opticni nevritis, bistveno zmanjšana ostrina vida, ki je ni mogoce korigirati, cepravje oftalmoloski status ob tem normalen, hiperemija ali slabša omejenost papile vidnega živca, relativni aferentni pupilarni defekt, pa tudi težave, nad katerimi tožijo bolni otroci (megleni vid, bolecina ob premikih zrkel). Rezultati so pokazali, da diagnoze opticni nevritis ni mogoce potrditi samo s klinicnim pregledom pri nobenem izmed 14 otrok, posebej ce ima otrok še relativno oster vid. Z elektrofiziološkimi meritvami smo pokazali odstopanja od normale le pri 4/14 otrocih s sumom na opticni nevritis. Pri njih je bil ERG (bliskovni in slikovni) normalen, VEP pa so bili zakasnjeni in znižani. Pri teh štirih otrocih suma na opticni nevritis nismo ovrgli, zato jih bomo povabili na kontrolni pregled. Otroci s potrjeno diagnozo multiple skleroze so imeli po pricakovanjih vecja odstopanja od normale, tako pri klinicnih kot tudi pri elektrofizioloških preiskavah. ZAKLJUCKI: Pri domnevnem opticnem nevritisu šolskih otrok je potrebna nadvse skrbna diagnosticna obdelava. Klinicne oftalmološke in funkcionalne preiskave so namrec za popolno oceno okvare vidne poti pri otrocih nezadostne, v precejšnji meri subjektivne in premalo napovedne, opticni nevritis, ceprav ne zelo pogosto, pa v atipicni obliki že lahko prvi znanilec nastajajoce multiple skleroze. K razjasnitvi diagnosticnih težav lahko prispevajo elektrofiziološke preiskave, saj se je izkazalo, da tudi pri otrocih dovolj zanesljivo pokažejo, na kateri ravni je okvarjena vidna pot. «» [Abstract / English version] Electrophysiologic evaluation of visual pathway in school children Author: Manca Tekavcic-Pompe Mentor: dr. Jelka Brecelj, znanstvena sodelavka Co-mentor: dr. Branka Stirn-Kranjc, dr.med. INTRODUCTION: Optic neuritis presents in adults differently than in children, in whom its clinical picture and the results of some investigations may often be atypical. That is why optic neuritis in children is a difficult diagnostic task. The results of some investigations, e.g. Haitz test, contrast sensitivity test and vision field test, are less objective in children than in adults. AIM: The most objective in the diagnostics of optic neuritis in adults are electrophysiologic tests. Our interest was to find out weather it is so also in diagnostics of optic neuritis in children. Children (14) referred with suspected optic neuritis to the Ophthalmology Department in Ljubljana. during the last two years were included into our study. METHODS: Ophthalmologic examination, vision field testing, Haitz test, contrast sensitivity and electrophysiologic tests (flash and pattern electroretinography - ERG, and visual evoked potentials - VEP) were performed in all of them. The results were compared with those of a group of healthy volunteers (14) of the same mean age, and with those of four children with the diagnosis of multiple sclerosis. RESULTS: The criteria that make an ophthalmologist think of optic neuritis in a child were found to be considerably reduced visual acuity that can not be connected in spite of otherwise normal ophthalmologic status, optic disc hyperaemia, blurred optic disc margins, relative afferent papillary defect, or subjective problems, e.g. blurred vision and pain to the eye movements. The diagnosis of optic neuritis can not be confirmed by clinical examination alone, especially if visual acuity is relatively well preserved. In 4 of our children with suspected optic neuritis the results of electrophysiologic tests were abnormal-VEP were delayed and decreased, while flash and pattern ERG were normal. However, the results were not convincing, and the children will be followed-up. Naturally, the results of clinical and electrophysiologic tests were markedly abnormal in children with multiple sclerosis. CONCLUSIONS: In children with suspected optic neuritis careful diagnostic evaluation is of great importance, since clinical and functional investigations are subjective and insufficient for a complete evaluation of the visual path defect. On the other hand, optic neuritis in an atypical form may, however rarely, already at this age precede and announce a demyelinating disease. With their ability to reliably point to the level of the visual path defect, electrophysiologic tests were proven to play an important role also in the diagnostics of visual problems in children.