加强对鞍区病变相关眼部表现的正确认识  

Deepen the understanding of the ocular finding related with sella region lesions

作　　者：张晓君[1] 魏文斌[2] 

机构地区：[1]首都医科大学附属北京同仁医院神经内科,100730 [2]北京同仁眼科中心

出　　处：《眼科》2012年第5期289-291,共3页Ophthalmology in China

摘　　要：鞍区与视通路之间紧邻的解剖关系决定了鞍区病变导致的眼部表现较为常见,其中某些病变可能与青光眼等传统认为属于原发于眼部的疾病相混淆。鞍区占位性病变压迫视交叉导致双颞侧偏盲等各种类型的视野缺损、视力下降以及视神经萎缩等是临床最为常见的眼部表现。了解不同类型鞍区占位性病变所致眼部以外的临床表现对肿瘤的早期诊断和治疗有重要意义。鞍区病变导致的视神经萎缩有时与青光眼性视神经病变混淆,是根据各自的临床特征性改变还是应对正常眼压性青光眼患者常规进行神经影像学检查进行鉴别?头颅MRI所示的"空蝶鞍"可以合并某些眼部表现,但是很可能二者之间并非因果关系而二者均为颅内压长期增高的结果。目前存在的对于鞍区病变的眼部表现以及相应眼部病变的不同认识,要求我们在正确认识相关疾病概念以及准确把握疾病特征的基础上,从科学研究、临床实践以及医学伦理学、卫生经济学等方面综合分析,合理选择诊断治疗方案,从而最大程度上使患者获益。The tight anatomic relationship between sella region and visual pathway makes the ocular findings caused by lesions in sella region pretty common clinically, some of which are hard to distinguished with the features of some conditions traditionally con- sidered as primary eye diseases. Different types of visual field defects such as hi-temporal hemianopia, vision loss and optic nerve atro- phy are common findings due to optic chiasm lesions caused by sella region mass. In addition to ocular findings, getting familiar with the systemic symptoms and sign of different kind of sella region tumors are helpful to early diagnosis and treatment. Optic neuropathy can be similar with glaucomatous optic neuropathy in some conditions. Should we distinguish them mainly based on typically clinical features or routinely perform image study for the patients diagnosed as normal tension glaucoma？ The empty sella found by brain MRI can co-exist with some ocular findings, but these two findings can both be the result of long-existing intracranial hypertension, instead of one can cause the other. The controversies about the relationship between sella region lesions and ocular finding require us take a com- prehensive way considering the aspects of research, clinical practice, medical ethic and economics to provide a good diagnostic and treatment stratagem for benefiting the patients most.

关 键 词：鞍区占位性病变 空蝶鞍症 视神经 青光眼 

分 类 号：R771.3[医药卫生—眼科]