前部缺血性视神经病变疗效欠佳临床分析  

Analysis of the reasons for treatment that are not satisfied with nonarteritic anterior ischemic optic neuropathy

作　　者：王润生[1] 吕沛霖[2] 张存丽[3] 张玉磊[3] 于彬科[3] 王红艳[3] 

机构地区：[1]中国陕西省西安市第四医院眼科,710004 [2]中国陕西省西安市第一医院眼科,710002 [3]陕西中医学院,中国陕西省咸阳市712083

出　　处：《国际眼科杂志》2009年第8期1598-1600,共3页International Eye Science

摘　　要：目的:分析非动脉炎性前部缺血性视神经病变(nonarteritic anterior ischemic optic neuropathy,NAION)治疗效果不满意原因,结合近年研究探讨治疗选择用药的依据。方法:NAION患者78例84眼,均提供有当地医院或首诊医院的荧光素眼底血管造影、眼底彩色相、视野、视力等资料,并符合NAION的诊断标准。治疗药物常选择糖皮质激素、血管扩张剂、高渗性脱水剂、营养神经药物等,同时应用或部分交叉应用,治疗时间1mo以上,从视力、视野、眼底、FFA,OCT检查结果分析药物治疗不满意的因素。结果:84眼经治疗后效果不满意患者,再次就诊时视盘水肿均消退,颜色明显变淡色泽不一致者65眼;视盘全部色淡不易分辨者19眼。复查造影,视盘部分轻度着色9例,其余视盘表现为无渗漏无着色。OCT检查31眼中盘周颞侧神经纤维厚度较正常人均值减少2/3者9眼,减少1/2者11眼,减少1/3者11眼,纵横十字扫描无视杯27眼,浅窄视杯4眼。所有病例在就诊时中心视力均较首诊医院治疗前下降4行以上,最多由1.5下降到0.04。11眼复查视野,结果缺损范围扩大>10°,或原相对缺损区变成绝对缺损区。糖皮质激素、血管扩张剂、高渗性脱水剂、营养神经药物等同时或部分交叉长期非个性化应用是导致疗效不满意的主要原因。结论:除疾病自身特点外,在发病后采取药物积极治疗及选择药物得当与否与疗效和预后密切相关,应尽可能缩短糖皮质激素应用时间,在NAION水肿期根据血黏度、血压、血糖、血脂、视杯形态采取针对性药物的个性化治疗,以提高疗效。AIM： To analyze the reasons satisfied with nonarteritic neuropathy（NAION）. for treatment that are not anterior ischemic optic METHODS： The treatment, effect of 84 eyes in 78 patients with NAION was not satisfied, and their clinical data such as fundus fluorescein angiography （FFA）, fundus photograph, field vision, central vision, etc were collected from local hospitals or the hospitals they were first attending, and they were all in accordance with the diagnostic criteria for NAION. The discontented curative effect was analyzed from many views： visual acuity, field of vision, fundus oculi, FFA and OCT. Preliminary analysis of glucocorticoid, vasodilator, hyperosmolar dehydration agents, neuroprotective drugs used in treatment period were made respectively. RESULTS： Seventy-eight patients of 84 eyes affected NAION that results were not satisfied with accepted clinical examination. All the optic discs showed no edema appearance. The pallor was seen no-asymmetry in 65 eyes. The pale of disc was seen in 19 eyes. From FFA, the optic disc noted staining in 9 eyes, and others appeared normal. On OCT image, the perepapillary optic nerve fiber thickness showed thinning at different degree in affected eyes. At cross-sectional scanning, there was absent optic cup in 27 eyes and supper shallow cup in 4 eyes respectively. The central visual acuity was decreased in 4 lines. The severe case that decreased from 200/200 to 20/400. These patient examined visual field defects in individuals. Such as glucocorticoid, vasodilator, hyperosmolar dehydration agents, neuroprotective drugs used to therapy this disease, though it was better to recovery, the long using and combination of these drugs were main causes of poor therapy in clinics. CONCLUSION： Based on conventional treatment, individuation treatment for NAION edema period according to the blood viscosity, blood pressure, blood sugar, blood fat and the cup form, can improve the therapeutic effect.

关 键 词：非动脉炎性前部缺血性视神经病变 疗效 

分 类 号：R774.6[医药卫生—眼科] R618.53[医药卫生—临床医学]