视交叉部病变黄斑神经节细胞复合体厚度图形形态特征性改变的临床意义  

The clinical features and value of macular ganglion cell complex thickness patterns in patients with optic chiasma lesion

作　　者：张利[1] 孙川[1] 孙心铨[1] 

机构地区：[1]中日友好医院眼科,北京100029

出　　处：《中华眼科杂志》2016年第5期335-342,共8页Chinese Journal of Ophthalmology

摘　　要：目的评价两种不同发病情况的视交叉部病变导致黄斑神经节细胞复合体厚度（mGCCT）图形形态特征性改变的临床意义。方法回顾性研究。16例视交叉部病变病例，其中男性10例，女性6例，年龄5～77岁（平均48岁）。其中垂体瘤9例、颅咽管瘤3例、视交叉部发育不良、脑膜瘤、血管瘤和动脉瘤各1例。对所有患者采用视野分析仪进行30。中心视野检查，并应用3D—OCT检查黄斑视网膜厚度（MRT）地形图、mGCCT地形图、视乳头周围神经纤维厚度（pRNFL）地形图，进行临床有意义的病损概率分析。结果16例视交叉部病变病例有两类不同临床表现：（I）14例患者（14／16）为慢性、长病程、渐进性伴mGCCT特征性中垂线划界的、双鼻侧mGCCT萎缩，相应视野呈双颞侧偏盲。（2）2例患者（2／16，均为垂体瘤）属慢性、短病程、有急进型发作、视力视野急剧下降、mGCCT肿胀或正常高限厚度，pRNFL厚度图形常可见视乳头颞侧缘黄斑鼻侧mRNFL萎缩变薄。结论慢性长病程、渐进性伴mGCCT特征性中垂线划界的、双鼻侧mGCCT萎缩，具有临床定位视交叉部病变的价值，与视野双颞侧偏盲具有同等诊断意义。慢性短病程伴有急进型发作的病例，mGCCT肿胀，但pRNFL常可显示视乳头颞侧旁单眼或双眼黄斑鼻侧mRNFL变薄，这类急进型发作病例需要与视野检查相互印证。Objective To evaluate patterns of macular retinal ganglion cell complex thickness （mRGCCT） in patients with two types of neurologie lesions in optic ehiasm region. Methods Retrospective case review study. Visual field test was conducted with automated perimetry （HAAG-STREIT OCTOPUS101 V6.07g Seven-in-One and 2010（HFA Ⅱ 750-40220-5.1.1/5.1.1） Carl Zeiss Meditee）, and visual field in the central 30 degree region was measured. Three types of thickness mapping including maeular retinal thickness （MRT）, maeular ganglion cell complex thickness （mGCCT） and peripapillary retinal nerve fiber layer （pRNFL） were recorded with TOPCON 3D-OCT 2000 spectral domain OCT. The results of OCT were compared with visual field. Results Sixteen cases were included in this study, male 10 cases, female 6 cases. Age 5 to 77 years （average 48.2）. Neurologie lesions including pituitary tumor （9 cases）, eraniopharyngioma （3 cases）, optic canal dysplasia in optic chiasm region （I case）, meningioma （1 case）, hemangioma （1 case） and aneurysm （1 case）. 14 cases have chronic, progressive, long course of disease, OCT showed characteristic perpendicular bisector delimitation, bilateral nasal mGCCT atrophy and corresponding temporal hemianopsia. 2 cases （both were pituitary tumor ） have a chronic, short duration, accelerated attack, visual acuity and visual field rapidly declined, mGCCT is swelling or approach high limit of normal range. In pRNFL thickness map, atrophy of mRNFL in temporal peripapillary and nasal macular region could be observed. Conclusions Chronic, progressive, long course of disease, combined with characteristic perpendicular bisector delimitation, bilateral nasal mGCCT atrophy and corresponding temporal hemianopsia is helpful to predict lesion of disease, mGCCT map is of equal importance with visual field test for diagnosis of lesion within optic chiasm. In cases with a chronic, short disease course, and accelerated attack, mGCCT could be swelling, but pRNFL could be thinn

关 键 词：视交叉 黄斑 视网膜神经节细胞 神经纤维 视乳头 体层摄影术 光学相干 

分 类 号：R774.5[医药卫生—眼科]