非动脉炎型前部缺血性视神经病变的临床特点分析  

Clinical features analysis of non-arteritic anterior ischemic optic neuropathy

作　　者：接英[1] 阮方[1] 李上[2] 郭纯刚[2] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,北京市100730 [2]首都医科大学附属北京佑安医院,北京市100069

出　　处：《眼科新进展》2016年第7期644-646,654,共4页Recent Advances in Ophthalmology

基　　金：国家自然科学基金资助(编号:81170824)~~

摘　　要：目的探讨非动脉炎型前部缺血性视神经病变(non-arteritic anterior ischemic optic neuropathy,NAION)的临床特点。方法回顾性分析2010年1月至2013年12月首诊于我院的66例(83眼)NAION患者的临床资料,包括视力、眼压、视野、荧光素眼底血管造影和OCT等检查结果,并对患者全身疾病进行相关分析,观察治疗过程中视力、视野恢复情况及眼底变化。结果在NAION患者中单眼49眼,双眼先后发病13眼,双眼同时发病4眼,其中,70%双眼先后发病的患者在对侧眼出现NAION时,先发病眼视力得到改善。OCT检查发现:NAION患者的视盘水肿主要发生于视盘的上方和下方,形成"双驼峰"状改变。在发病早期20眼发生黄斑中央凹神经上皮层脱离。发生黄斑渗出的眼中80%合并糖尿病。结论颞侧视盘的神经纤维层增厚牵拉所导致的中心凹神经纤维层脱离,可能是早期NAION视力低的因素。双眼发病的NAION患者,可能存在双眼视盘供血代偿机制,来减轻一侧视盘的损害。Objective To describe the clinical characteristics of nonarteritic anterior ischemic optic neuropathy（ NAION）. Methods The ophthalmic and clinical data of 66 first-visit NAIONpatients（ 83 eyes） from January 2010 to December 2013 were retrospectively analyze.Ophthalmic examinations included visual acuity,intraocular pressure,visual fields,fluorescein fundus angiography and OCT. And the system diseases were also analyzed,the changes of visual acuity,visual field recovery and fundus were observed. Results Among all the NAIONpatients,there were 49 monocular cases,13 binocular successive cases,and 4 binocular simultaneous cases.In the 13 patients mentioned above,the visual acuity in about 70% improved when the fellow eye had NAION,too. OCTexaminations show ed that papilloedema of the NAIONpatients were taken place in above and below the optic disc with double-hump-shape. In the early stage of this disease（ within 1 week）,20 eyes had macular fovea retinal nerve fibre layer detachment. And80% of patients with macular exudation also got diabetes mellitus. Conclusion The thickening of bitamporal optic disc retinal nerve fibre layer causes the detachment of macular fovea retinal nerve fibre layer,which may explain the low visual acuity in the early stage of NAION. We hypothesize that poor microcirculation perfusion in the bilateral optic disc can be relieved by sacrificing the blood supply of one optic disc.

关 键 词：非动脉炎型前部缺血性视神经病变 缺血再灌注 黄斑 视盘 

分 类 号：R774.6[医药卫生—眼科]