放射性视神经病变的临床和影像学特征分析  

Analysis of clinical and imaging characteristics of radiation-induced optic neuritis

作　　者：王永平[1] 周欢粉[1] 付俊霞 李洪恩 宋宏鲁 魏世辉[1] Wang Yongping;Zhou Huanfen;Fu Junxia;Li Hongen;Song Honglu;Wei Shihui(Department of Ophthalmology,Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第一医学中心,北京100039

出　　处：《中华眼底病杂志》2022年第12期994-1000,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：政府间国际科技创新合作重点专项(2018YFE0113900)。

摘　　要：目的观察放射性视神经病变(RION)的临床及影像学特征。方法回顾性临床研究。2010年至2021年于解放军总医院眼科检查确诊的RION患者43例69只眼纳入研究。其中,男性23例36只眼;女性20例33只眼。放射治疗(以下简称为放疗)时年龄(49.54±13.14)岁。放疗实体病灶中心剂量(59.83±14.12)Gy。联合化学药物治疗(以下简称为化疗)16例。所有患者均行最佳矫正视力(BCVA)、眼底彩色照相检查;同时行光相干断层扫描(OCT)检查46只眼;视野检查30只眼;眼部核磁共振成像(MRI)检查40只眼。BCVA检查采用Snellen视力表进行,记录时换算为最小分辨角对数(logMAR)视力。行腰椎穿刺脑脊液检查12例。行高压氧治疗(HBOT)10例13只眼;静脉滴注甲基强的松龙(IVMP)治疗9例12只眼;HBOT联合IVMP治疗12例23只眼;仅行基础治疗12例21只眼。并据此分为HBOT组、IVMP组、HBOT联合IVMP组及对照组。观察患眼发病时、恢复时、最终的BCVA和视盘周围神经纤维层(RNFL)、黄斑区内界膜-视网膜色素上皮(ILM-RPE)层厚度变化,以及不同治疗方式BCVA最终结局。不同病程者以及不同治疗方案组RNFL、ILM-RPE层厚度比较采用独立样本t检验。结果43例患者中,单眼、双眼分别为17(39.53%,17/43)、26(60.47%,26/43)例。完成放疗至出现视力下降的时间为(36.33±30.48)个月。RION病程1周~10年,其中病程≤2个月者37只眼。亚急性视力下降41只眼。logMAR BCVA<1.0、1.0~0.3、>0.3分别为45、15、9只眼。RION病程2个月内视盘苍白、水肿分别为10(27.03%,10/37)、3(8.11%,3/37)只眼。与病程<1个月时比较,病程1个月时,视盘上方RNFL[95%可信区间(CI)2.08~66.56,P=0.038]、黄斑区外环上方ILM-RPE层(95%CI 4.37~45.39,P=0.021)厚度明显变薄;病程2个月时,黄斑中心区ILMRPE层明显增厚(95%CI-32.95~-4.20,P=0.015);病程3~6个月时,黄斑区内环颞侧ILM-RPE层明显增厚(95%CI-42.22~-3.83,P=0.022);病程>6个月时,视盘RNFL除颞侧外均�Objective To observe the clinical and imaging characteristics of radiation optic neuropathy(RION).Methods A retrospective clinical study.A total of 43 patients(69 eyes)who were diagnosed with RION at the Chinese PLA General Hospital from 2010 to 2021 were included in this study.There were 23 males(36 eyes)and 20 females(33 eyes).The age of patients at the time of radiation therapy was 49.54±13.14 years.The main dose of radiotherapy for lesions was 59.83±14.12 Gy.Sixteen patients were treated with combined chemotherapeutic agents.The clinical details of best corrected visual acuity(BCVA)and color photography of the fundus were collected.Forty-six eyes underwent optical coherence tomography(OCT),visual field were examined in 30 eyes,magnetic resonance imaging(MRI)were performed in 40 eyes.The BCVA examination was performed using Snellen visual acuity chart,which was converted to minimum resolution angle logarithm(logMAR)visual acuity during recording.Hyperbaric oxygen therapy(HBOT)was performed in 10 patients(13 eyes),9 patients(12 eyes)were treated with intravenous methylprednisolone(IVMP),12 patients(23 eyes)were treated with HBOT combined with IVMP and control group of 12 patients(21 eyes)were only treated with basal treatment.And grouped accordingly.To observe the changes in onset,recovery,and final BCVA of the affected eye as well as thickness changes of the retinal nerve fiber layer(RNFL)of the optic disc and inner limiting membrane-retinal pigment epithelium(ILM-RPE)layer of the macular area,and final outcome of BCVA with different treatment modalities in affected eyes.The RNFL and ILM-RPE layer thicknesses were compared between patients with different disease duration as well as between treatment regimens using independent samples t-test.Results Of the 43 cases,vision loss was monocular in 17 patients(39.53%,17/43)and binocular in 26 patients(60.47%,26/43).The latency from radiotherapy to onset of visual loss was 36.33±30.48 months.The duration of RION ranged from 1 week to 10 years,in which the disease

关 键 词：放射性视神经病变 体层摄影术 光学相干 磁共振成像 高压氧疗法 静脉注射甲基强的松龙 

分 类 号：R774.6[医药卫生—眼科]