特发性脱髓鞘性视神经炎病程中视网膜神经纤维层厚度与视野缺损变化的关系研究  

Relationship between retinal nerve fiber layer thickness and visual field defects in the process of idiopathic demyelinated optic neuritis

作　　者：蒋官森[1] 马嘉[2] 袁援生[2] 魏世辉[3] 蔡斌[2] 李艳梅[2] 

机构地区：[1]云南省曲靖市第一人民医院眼科,曲靖655000 [2]昆明医科大学第一附属医院眼科,昆明650032 [3]中国人民解放军总医院眼科,北京100853

出　　处：《中国眼耳鼻喉科杂志》2015年第3期163-169,174,共8页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：云南省卫生厅内设机构科技项目(2012ws0016)

摘　　要：目的探讨特发性脱髓鞘性视神经炎(IDON)患者视盘周视网膜神经纤维层(RNFL)厚度与视野缺损变化的关系,评估结构损害与视功能损害和恢复的相关性。方法前瞻性对入院诊断为单眼IDON的65例患者的患眼和对侧眼,分别在糖皮质激素冲击与序贯治疗前和治疗后3、6、12个月进行Humphrey视野计标准自动视野检查,相干光断层扫描(OCT)视盘周各位点方向的RNFL厚度。将视野缺损计分与不同位点神经纤维层厚度分别进行对比,研究IDON患者结构和功能损害的特点,同时将结构与功能损害进行相关性分析。结果 1治疗前患眼与对侧眼平均RNFL厚度组间差异无统计学意义(P=0.759),发病后3、6、12个月,患眼的平均RNFL及上、下、鼻、颞侧RNFL均进行性变薄(P<0.05),而对侧眼的RNFL未见显著改变(P>0.05)。随访12个月后,患眼各钟点位出现RNFL受损比例不同,以视盘的上、下极纤维束区受损最为严重。2患眼视野计分在治疗前与治疗后3、6、12个月相比,差异有统计学意义(P<0.05);而随访的3、6、12个月间差异无统计学意义(P>0.05)。3随访3、6、12个月的视野计分与下方RNFL厚度呈负相关(P<0.05);6、12个月视野计分与平均RNFL呈负相关(P<0.05);12个月时视野计分与上方RNFL呈负相关(P<0.05)。视野计分与鼻侧和颞侧RNFL变化均无相关性(P>0.05)。12个月后,视野计分与12、1、5、6、7的5个钟点位呈负相关(P<0.05),其余各钟点位与视野计分无相关性(P>0.05)。视盘与视野损害在早期具有较高的一致性。4按照Garway-Heath视盘与视野分区对应关系,12个月时视盘与视野损害较一致性的区域以第Ⅵ和第Ⅰ区最多见,其次是第Ⅱ和第Ⅲ区,视野损害在乳斑束对应区及早期发生损害的区域有明显改善。结论 1IDON患者在发病后RNFL进行性变薄,尤以3个月内变薄最明显,视盘上、下极偏颞侧最先出现可检测的RNFL损害,且下极先于上极出现损害,Objective To explore the relationship between the retinal nerve fiber layer （RNFL） thickness around the optic disc and the visual field defects in patients with idiopathic demyelinated optic neuritis （IDON）, and to evaluate the relationship between structure and function. Methods The standard visual field tests with Humphrey automatic perimetry （HPA） and the RNFL thickness around the optic disc with optical coherence tomography （OCT） were measured in 130 eyes （ both 65 affected eyes and 65 control eyes） of 65 patients with monocular IDON before and 3, 6,12 months after regular glucocorticoid treatment. The relationship between the visual field scores and the RNFL thickness at different o＇clock was analyzed respectively in order to study the characteristics and relationship between the structural damages and the functional damages. Results （1）There was no significant difference in the average RNFL thickness between the affected eyes and the;contralateral eyes before the treatment （P = 0.759）. There were significant progressive defects in the affected eyes of average RNFL and RNFL in the upper, lower, nasal and temporal quadrants during the following 3, 6 and 12 months （P 〈 0.05）, whereas, there was no significant change in the contralateral eyes （P 〉 0.05 ）. RNFL thickness was damaged the most sig41ificantly at the superior and inferior poles of the optic disc at 12th month. （2）There were significant differences of the visual field scores between before treatment and in the followed 3, 6 and 12 months after the treatment （ P 〈 0.05 ） , but no difference between 3, 6 and 12 months one another （P 〉 0.05）. （3）There were negative correlations between the visual field scores and the RNFL thickness of the lower quadrants in the followed 3, 6 and 12 months （P 〈 0.05 ）, between the visual field scores and the average RNFL thickness in the followed 6 and 12 months （P 〈 0.05）, and between the visual field scores and the RNFL thickness of the upper qua

关 键 词：特发性脱髓鞘性视神经炎 视野 视网膜神经纤维层 视功能 

分 类 号：R744.5[医药卫生—神经病学与精神病学]