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<meta name="description" content="小児の視覚障害の原因の84％は0歳代で起こっており，この時期の疾患は例え軽度であっても視覚予後を左右する可能性がある．本書では，苦手意識をもつ眼科医が多い，3歳児未満，特に“０歳児から”の小児眼科診療にこだわり，役立つ知識とノウハウを分かりやすく解説した．　　【シリーズ概要】　「日常臨床にすぐ役立つ」をコンセプトとした「眼科プラクティス」の最新シリーズ．今シリーズでは図版をより効果的に示すことで，">

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		<h1 class="catchCopy">眼科診療のスタンダードをビジュアルに解説！実践的シリーズの決定版!!</h1>
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		<h2 class="series">新篇眼科プラクティス&nbsp;&nbsp;19</h2>
		
		<h1 class="title">0歳児から始める！小児眼科診療<span class="version"></span></h1>
		

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					編集：仁科幸子（国立成育医療研究センター）
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					シリーズ監修：大鹿哲郎（筑波大学教授）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">小児の視覚障害の原因の84％は0歳代で起こっており，この時期の疾患は例え軽度であっても視覚予後を左右する可能性がある．本書では，苦手意識をもつ眼科医が多い，3歳児未満，特に“０歳児から”の小児眼科診療にこだわり，役立つ知識とノウハウを分かりやすく解説した．<br><br>【シリーズ概要】<br>「日常臨床にすぐ役立つ」をコンセプトとした「眼科プラクティス」の最新シリーズ．今シリーズでは図版をより効果的に示すことで，さらにビジュアル面を大幅強化．直感的に理解できる「視る教科書」を目指した．</section><section class="preface">「0歳児から始める！小児眼科診療」序文<br><br>　近年，新生児医療は新たな進歩を遂げています．産科・小児科領域では，従来からの先天代謝異常の疾患群に加えて，原発性免疫不全症，脊髄性筋萎縮症，ライソゾーム病，ペルオキシソーム病を対象疾患に含める拡大新生児マススクリーニングの実証が話題となっています．酵素補充療法，骨髄移植，遺伝子治療・核酸医薬などの目覚ましい進歩によって，新生児期の超早期診断が飛躍的な予後向上につながる疾患が出てきているからです．同じ感覚器領域でも，難聴に対しては，2016年から新生児聴覚スクリーニングが公費助成となり，全国の80％以上に拡大して実施され成果を上げています．さらに今後は，先天性心疾患マススクリーニング，新生児サイトメガロウイルス感染症への領域拡大が検討されています．近い将来には，ゲノム新生児スクリーニング，ゲノム出生前スクリーニング，妊娠前スクリーニング・着床前診断も身近なものとなることでしょう．<br>　一方，眼科領域では，懸案事項であった3歳児眼科健診における屈折検査の導入が急速に進んで，弱視の検出精度が格段に向上しています．しかし，新生児・乳児期における効果的な視覚スクリーニングは依然として普及していません．小児の視覚障害の原因疾患の約84％は0歳代で起こっています．また，0～2歳児の視覚は発達途上で感受性が高いため，たとえ軽症の疾患であっても，早期に異常を発見して治療や管理を行っていくことが予後を左右することとなります．<br>　我々眼科医や視能訓練士は専門家として，産科・小児科医，保健師，乳幼児に関わる多職種と緊密に連携をとっていく必要があります．そして，保護者の目や耳に向けて，乳幼児の眼に対する日頃の注意を喚起して，気になることがあれば0歳から眼科へ受診してもらうこと，眼科で0歳から視覚を管理していくことが喫緊の課題です．<br>　昨今，少子化や効率化を背景として，小児を診ること，特に3歳未満の小児に苦手意識をもつ眼科医，視能訓練士が増えているのではないでしょうか？　0歳児が眼科へ来院したときのために，0歳児からの眼科診療に関わる知識とノウハウを，本書を通じて着実に身につけていただくよう願っております．<br>　最後に，小児診療の現場に立ち奮闘する毎日のなかで，ご執筆をいただきました先生方に深く御礼申し上げます．<br><br>　2025年4月<br>　仁科幸子</section><section class="indexes">【総論】	<br>　すべての小児に良い視機能を	<br>	<br>【解説】	<br>Ⅰ．小児の視機能の発達と障害		<br>　1．眼の発生と疾患	<br>　［T］眼発生に関与する遺伝子	<br>　2．眼球の形態の発達	<br>　3．小児の視力の発達	<br>　4．さまざまな視機能の発達	<br>　5．視覚の感受性期間と弱視	<br>　6．斜視による視機能障害	<br>　［T］社会環境の変化と斜視	<br>Ⅱ．視覚異常の早期発見		<br>　1．0歳から始める視覚スクリーニング	<br>　［T］諸外国における乳幼児の視覚スクリーニング	<br>　［O］眼症状を伴う全身疾患に注意	<br>　2．“3歳児健診”における視覚検査	<br>　［O］視覚スクリーニング機器の使用法	<br>　3．小児科・保健師と眼科の連携	<br>　4．園医・学校医による健診	<br>Ⅲ．小児眼科診療の第一歩		<br>　1．小児の検査の進め方	<br>　［O］０歳児をどう診るか	<br>　2．眼位・眼球運動・両眼視機能検査	<br>　3．視力検査	<br>　［O］小児の視力検査の注意点	<br>　4．精密屈折検査	<br>　［O］眼軸長の測定法	<br>　5．前眼部の診かた	<br>　［A］ 眼圧測定法	<br>　6．眼底の診かた	<br>　［A］スマートフォンを用いた眼底撮影	<br>　7．視野の測り方	<br>　8．眼科外来でできる画像検査	<br>　9．電気生理学的検査	<br>　［A］全身麻酔下検査・鎮静下検査	<br>Ⅳ．小児の眼疾患を知る		<br>　1．外眼部・前眼部疾患	<br>　　1）眼瞼・睫毛疾患<br>　　2）涙道疾患<br>　　3）角結膜疾患<br>　　4）前眼部形成異常・無虹彩症<br>　　5）水晶体疾患<br>　［A］先天白内障術後の長期経過<br>　　6）緑内障<br>　［A］小児緑内障の治療の注意点<br>　2．後眼部疾患	<br>　　1）小眼球・ぶどう膜欠損<br>　　2）胎生血管系遺残<br>　　3）未熟児網膜症<br>　［A］未熟児網膜症に対する抗VEGF療法<br>　　4）家族性滲出性硝子体網膜症<br>　　5）Coats病<br>　　6）Leber先天黒内障・早発型網膜ジストロフィ<br>　［A］遺伝性網膜ジストロフィに対する遺伝学的検査<br>　　7）杆体1色覚<br>　　8）黄斑ジストロフィ<br>　［A］小児期にみられるまれな網膜ジストロフィ<br>　［A］遺伝子治療・新規治療法の展望<br>　　9）ぶどう膜炎<br>　　10）網膜芽細胞腫<br>　3．神経・筋疾患	<br>　　1）視神経形成異常<br>　　2）視神経炎・視神経症<br>　　3）重症筋無力症<br>　4．眼窩疾患	<br>　5．全身疾患に伴う眼疾患	<br>　　1）先天代謝異常<br>　　2）母斑症<br>　　3）色素失調症<br>　　4）Stickler症候群・類縁疾患<br>　　5）中枢性視覚障害<br>　6．心因性視覚障害	<br>　7．神経発達症	<br>　8．色覚異常	<br>　9．眼外傷	<br>　［T］虐待による眼外傷	<br>　［O］保護眼鏡の推奨	<br>Ⅴ．小児に対する治療の基本		<br>　1．眼鏡による治療	<br>　2．コンタクトレンズによる治療	<br>　3．薬物治療	<br>　4．レーザー治療	<br>　5．手術治療	<br>　［O］小児と保護者への説明をどうするか	<br>　6．鎮静と麻酔	<br>Ⅵ．小児を育む連携と支援		<br>　1．視覚障害児に対する医療・福祉・教育機関の連携	<br>　2．ロービジョンケアの進め方	<br>　［O］教育機関と連携した早期ケア	<br>　［A］重複障害児に対する支援	<br>　［A］視覚障害児が受けられる福祉制度	<br>　3．神経発達症に対する連携と支援	<br>　4．被虐待児症候群に対する連携と支援	<br>　5．遺伝相談<br><br>索引<br><br>Advanced Techniques=［A］<br>One Point Advice=［O］<br>Topics=［T］<br><br></section></article>
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