非动脉炎性前部缺血性视神经病变患者急性期视盘周围脉络膜血流信号分析  

Analysis of peripheral choroidal blood flow signal in acute stage of nonarteritic anterior ischemic optic neuropathy patients

作　　者：巩迪 张利[1] 赵通[1] 尹玥 王志军[1] 陈宜[1] GONG Di;ZHANG Li;ZHAO Tong;YIN Yue;WANG Zhijun;CHEN Yi(Department of Ophthalmology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院眼科,北京市100029

出　　处：《眼科新进展》2021年第4期359-363,共5页Recent Advances in Ophthalmology

摘　　要：目的利用光学相干断层扫描血管成像(OCTA)观察非动脉炎性前部缺血性视神经病变(NAION)患者急性期的视盘周围脉络膜血流信号特征。方法对2017年1月至2019年9月首次确诊为NAION且接受OCTA检查的13例(13眼)患者进行回顾性横断面研究。由两位医师分别定性分析OCTA中脉络膜毛细血管层的血流信号中的低信号区,并分区。将分区的结果与en face OCT、视野检查结果进行对比。患者均至少随访1个月。结果急性期NAION患眼的视盘OCTA在脉络膜毛细血管层水平的低信号区可分为视盘本身部位、视盘水肿部位和沿神经纤维方向延伸部位3个区域。13眼中,10眼首次就诊时出现3个低信号区,2眼在第2次就诊时出现3个低信号区,1眼仅出现视盘本身部位和视盘水肿部位的低信号区。其中,沿神经纤维方向延伸部位的低信号区与视野缺损关系密切,对应比例达91.6%,该低信号区平均出现时间为发病后19.9 d。随访期内,9眼沿神经纤维方向延伸部位的低信号区出现神经纤维层萎缩。结论NAION患者急性期的视盘周围脉络膜层面的血流信号可以通过OCTA提示神经纤维层水肿、消退以及萎缩的变化过程。Objective To observe the characteristics of peripheral choroidal blood flow signal in acute stage of nonarteritic anterior ischemic optic neuropathy(NAION)by optical coherence tomography angiography(OCTA).Methods Retrospective cross-sectional study was conducted in 13 patients(13 eyes)newly diagnosed with NAION from January 2017 to September 2019.Two independent doctors qualitatively analyzed the low signal areas in the blood flow signals of peripapillary choriocapillary layer in OCTA and divided them into different regions.The results of the partition were compared with the results of en face OCT and visual field examination.Results The low signal area of optic disc OCTA in patients with NAION was divided into three parts the optic disc itself,the edema part of optic disc,and the part extending along the direction of nerve fibers.Of the 13 eyes,10 eyes showed 3 low signal areas at the first visit,2 eyes showed 3 low signal areas at the second visit,and only the signal areas of the optic disc itself and the optic disc edema were present in the eyes.Among them,the low signal areas along the extension of nerve fibers were closely related to the visual field defect,and the corresponding proportion was 91.6%.The average time of low signal area was 19.9 days after onset.Finally,atrophy of nerve fiber layer appeared in the low signal area along the extension direction of nerve fiber in 9 patients during follow-up.Conclusion OCTA can provide the changes in edema,regression and atrophy of the nerve fiber layer around the optic disc in patients with NAION in the acute stage through the blood flow signal of choroidal layer.

关 键 词：光学相干断层扫描血管成像 非动脉炎性前部缺血性视神经病变 脉络膜血流 

分 类 号：R774[医药卫生—眼科]