光学相干断层扫描技术在前部缺血性视神经病变不同病程中的应用  

Application of OCT in different disease course of anterior ischemic optic neuropathy

作　　者：赵朋波 周剑[2] 苏艳[2] 李丽[2] 闫晓玲[2] 谷心怡 吴鲁华[3] 韦企平[2] 

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学第二附属医院东方医院,北京100078 [3]北京中医药大学第三附属医院,北京100029

出　　处：《中国中医眼科杂志》2016年第1期23-27,共5页China Journal of Chinese Ophthalmology

基　　金：国家自然科学基金面上项目(81173307)

摘　　要：目的探讨前部缺血性视神经病变(AION)视盘周围视网膜神经纤维层(RNFL)厚度与病程发展之间的关系。方法回顾性临床研究。2011年1月—2015年1月北京中医药大学第二附属医院东方医院门诊确诊AION,并行频域光学相干断层扫描(FD-OCT)检查视盘周围RNFL厚度的患者45例(54只眼),年龄(58.41±10.33)岁;双眼发病9例,单眼发病36例;不伴全身性疾病者10例,伴有全身性疾病者35例;屈光度-4.00 D^+4.00 D;随访资料最大病程>365 d。选取年龄匹配、无眼部疾病的健康志愿者31例(62只眼)的RNFL厚度结果作为正常对照。分析AION眼不同病程阶段的RNFL厚度变化;比较单眼AION患者患眼及对侧健眼的RNFL厚度差异;以不合并全身性疾病AION患者为参照,分析全身性疾病对AION患眼RNFL厚度的影响。结果 AION发病后1~10 d内平均RNFL厚度增厚,在11~20 d达最高峰;在21~30 d、31~40 d开始下降,水肿消退;41~90 d RNFL开始发生薄变;在91~365 d显著薄变;>365 d后,薄变程度趋于稳定。在各个象限中,下方象限水肿最严重;鼻侧、颞侧象限最先受损。单眼AION患眼相对对侧健眼的RNFL厚度变化情况大致相同。合并全身性疾病AION眼的早期盘周RNFL增厚及晚期RNFL薄变均较不伴全身性疾病者明显。结论 AION盘周RNFL厚度存在早期增厚,中晚期变薄的特点。利用OCT测量RNFL厚度,是监测AION疾病发展过程的有效手段。OBJECTIVE To investigate the relationship between retinal nerve fiber layer（RNFL） thickness of the anterior ischemic optic neuropathy and the development course of the disease. METHODS A retrospective clinical study was adopted in the study. All the patients of the anterior ischemic optic neuropathy were diagnosed in the outpatient department of the Dongfang Hospital from January 2011 to January 2015.They were checked by frequency domain optical coherence tomography（FD-OCT） for RNFL thickness of optic disk. Among the 45 cases of the patients mean age was 58.41±10.33 with 9 cases of onset of both eyes while 36 cases with onset of a single eye.Thirty-five cases associated with systemic disease while 10 cases did not. Diopter range was-4.00 to ＋ 4.00 D; The maximum duration of follow-up was more than 365 d. The 31 age-matched healthy volunteers（62 eyes） with normal RNFL thickness and no eye diseases was selected as normal controls. Then analyzed the RNFL thickness change of AION patients in different stages of the disease, comparing the difference of the RNFL thickness between the affected eye and the contralateral healthy eye of AION patients suffering from a single eye; and analyzed the influence of systemic diseases on RNFL thickness, using AION patients with no systemic diseases as a reference.RESULTS The average RNFL thickness increased during 1st-10 thdays after the onset of AION; and it rose to the top in 11th-20thdays; In the stage of 21st-30 thdays and 31 stto 40thdays, it began to decline, while the edema subsided at the same time; during 41st-90 thdays, on average, the RNFL thickness started to become thinner; during the 91st-365 thday the RNFL thickness became thinner significantly; after 365 days, thin degree tended to be stable. The study also showed that edema was the most serious in the lower quadrant of the four quadrants, and the nasal side as well as temporal quadrant was firstly damaged. The RNFL thickness changes of the sick eye of Monocular AION were roughly the same with changes

关 键 词：前部缺血性视神经病变 光学相干断层扫描 视网膜神经纤维层厚度 

分 类 号：R774.6[医药卫生—眼科]