非动脉炎性前部缺血性视神经病变患者眼底影像检查特征及其与视力、病程转归的关系  

Ophthalmoscopic image characteristics and relation with vision and course of disease in nonarteritic anterior ischemic optic neuropathy

作　　者：韩梅[1] 陈松[1] 王兰惠[1] 解士勇[1] 时冀川[1] 

机构地区：[1]天津市眼科医院,300020

出　　处：《中华眼底病杂志》2010年第4期314-318,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察非动脉炎性前部缺血性视神经病变（NAION）患者的荧光素眼底血管造影（FFA）与光相干断层扫描（OCT）检查等影像特征，探讨其与视力、病程转归的关系。方法回顾分析47例临床确诊的NAION患者47只眼的FFA、OCT检查资料。所有患者均接受视力、眼底、视野等常规眼科检查。初诊时同时进行FFA和OCT检查。FFA及视野检查按常规方法进行；OCT检查分别选择线性和环形扫描方式，进行黄斑和视盘的扫描。其中35例NAION患者分别于发病后0．5、1、2、3、6个月时进行OCT复查。回顾分析时，以36例患者的对侧健眼作为对照组，对比分析患眼FFA、视野、视盘OCT图像特征与视力、病程转归的相互关系。结果FFA检查结果显示，所有患眼均表现为早期视盘充盈迟缓，晚期视盘呈强荧光渗漏，24只患眼在黄斑区出现强荧光渗漏。OCT检查结果显示，所有患眼视盘隆起，生理凹陷变窄或消失；视盘与黄斑（盘斑）之间神经上皮层组织增厚或神经上皮层隆起，下方有液性暗区。对照眼中，14只眼有正常视盘生理凹陷，22只眼无生理凹陷或较小的生理凹陷。NAION组0．5个月时黄斑中心凹处神经上皮层厚度、盘斑间神经上皮层最大厚度，视盘周围视网膜神经纤维层厚度均高于对照组，差异均有统计学意义（F=6．51，26．12，75．49；P＜0．05）。2个月时盘斑间神经上皮层最大厚度、视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度较0．5个月时变薄。3个月时视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度较0．5个月时明显变薄，低于对照组，差异有统计学意义（F=75．49，37．92；P〈0．05）。视野检查结果显示，下方视野缺损21例，占45．7％。OCT检查结果显示，随病程进展，视盘上方神经纤维层厚度下降的程度更明显，与视野的表现相一致。视�Objective To observe the characteristics of fundus fluorescein angiography（FFA）and optical coherence tomography （OCT）in nonarteritic anterior ischemic optic neuropathy （NAION）, and investigate its relation with visual acuity and course of disease. Methods The clinical data of 47 patients （47 eyes） with NAION were retrospectively analyzed. All the patiens had undergone visual acuity, fundus and visual field examination,meanwhile FFA and OCT were carried out at first visit. FFA and visual field were carried out by routine. OCT was carried out by line and circle shape scanning in macula and optic disc. Thirty-five NAION patients were checked with OCT at half, one, two, three and six month after onset in respectively. Take the healthy fellow eyes of 36 NAION patiens as control group. The FFA, visual field, OCT characteristics and relation with visual acuity and course disease were comparatively analyzed. Results FFA showed that all the eyes appear as delayed filling of the optic disc in early stage and hyperfluorescence leakage of the optic disc in late stage,besides hyperfluorescence presented to macular area in 24 eyes. OCT showed that optic papilla swelling and physiological depression narrow or nearly disappearance, neuroepithelial layer thickening or neuroepithelial layer eminence and subretinal fluidity area opaca between optic disc and macula. There were 14 eyes with normal physiological depression and 22 eyes with small physiological depression or non physiological depression in control group. Half month after onset, the neuroepithelial layer thickness of macula fovea, the maximum thickness of neuroepithelial layer between optic disc and macula, and the average retinal nerve fiber layer（RNFL）thickness in NAION group were higher than those in the control group,the difference were statistically significant （F= 6.51,26.12,75.49; P〈0.05）. Two months after onset,the maximum thickness of neuroepithelial layer between optic disc and maeula, the average RNFL thickness, and the RNFL thickness

关 键 词：视神经病变 缺血性/诊断 荧光素血管造影术/利用 体层摄影术 光学相干/利用 视野检查法/利用 

分 类 号：R774.6[医药卫生—眼科]