继发于眼外恶性肿瘤的浸润性视神经病变的临床和影像学特征  

Clinical and imaging features of infiltrative optic neuropathy secondary to extraocular malignant tumors

作　　者：孙传宾[1] 马志琼 Sun Chuanbin;Ma Zhiqiong(Eye Center,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Ophthalmology,Affiliated Xiaoshan Hospital,Hangzhou Normal University,Hangzhou 311202,China)

机构地区：[1]浙江大学医学院附属第二医院眼科中心,杭州310009 [2]杭州师范大学附属萧山医院眼科,杭州311202

出　　处：《中华眼底病杂志》2023年第6期476-482,共7页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察继发于眼外恶性肿瘤的浸润性视神经病变(ION)的临床表现和影像学特征。方法回顾性病例研究。2017年1月至2022年10月于浙江大学医学院附属第二医院眼科中心神经眼科门诊检查确诊的继发于眼外恶性肿瘤的ION患者20例26只眼和继发于颅内转移癌的早期视盘水肿(EP)患者16例32只眼纳入研究。所有患眼均行最佳矫正视力(BCVA)、眼底彩色照相、眼眶和(或)颅脑核磁共振成像(MRI)检查。行视野检查54只眼,其中ION、EP分别为22、32只眼。回顾分析患眼临床和影像学特征。结果ION患者20例26只眼中,男性13例,女性7例;年龄(52.8±16.9)岁。原发性恶性肿瘤为血液系统恶性肿瘤10例,眼眶周围恶性肿瘤7例,肺癌、胃癌、乳腺癌、前列腺癌分别为2、1、1、1例;其中2例鼻腔淋巴瘤患者同时记入血液系统恶性肿瘤及眼眶周围恶性肿瘤。既往有全身或眼眶周围恶性肿瘤病史者16例,其中患者自诉已“临床治愈”4例。既往诊断为视神经炎15例。E P患者16例中,男性5例,女性11例;年龄(47.9±12.3)岁。原发性恶性肿瘤为肺癌、乳腺癌、白血病、胃癌、卵巢癌、结肠癌、直肠癌分别为7、2、2、2、1、1、1例。ION 26只眼中,主诉视物模糊或周边视野遮挡且进行性加重20只眼;无明显视觉症状6只眼。BCVA为无光感~1.0,中位数0.3,其中光感、无光感4只眼。视盘水肿19只眼;未见明显异常7只眼。行视野检查的22只眼中,正常或生理盲点轻度扩大3只眼;弓形暗点4只眼;环形暗点6只眼;管状视野或全周视野向心性收缩6只眼;弥漫性光敏感度下降3只眼。MRI均表现为视神经弥漫性或局限性增粗,伴视神经鞘膜强化。EP 32只眼中,主诉反复发作的一过性黑矇28只眼;水平复视4只眼。BCVA为0.8~1.5,中位数1.0。所有EP患眼眼底检查均表现为不同程度的视盘充血水肿。视野检查表现为正常或生理盲点轻度扩大。MRI表现为视Objective To observe the clinical and imaging features of infiltrative optic neuropathy(ION)secondary to extraocular malignant tumors.Methods A retrospective case study.From January 2017 to October 2022,26 eyes of 20 patients with ION secondary to extraocular malignancies and 32 eyes of 16 patients with early papilloedema(EP)secondary to intracranial metastatic carcinoma were included in the study.All eyes underwent best corrected visual acuity(BCVA),fundus color photography,orbital and/or craniocerebral magnetic resonance imaging(MRI).A total of 54 eyes were examined by visual field examination,among which ION and EP were 22 and 32 eyes,respectively.Clinical and imaging features of the affected eye were retrospectively analyzed.Results Among 26 eyes of 20 ION patients,there were 13 males and 7 females,with the mean age of(52.8±16.9)years.There were 10 patients of hematologic malignancy,7 patients of periorbital malignancy,2 patients of lung cancer,1 patient of gastric cancer,1 patient of breast cancer and 1 patient of prostate cancer.Two patients of nasal lymphoma were recorded as hematologic malignancies and periorbital malignancies.Sixteen patients had a history of systemic or periorbital malignancy,among which 4 patients reported that they had been"clinically cured".Optic neuritis was diagnosed in 15 patients.Among the 16 patients with EP,5 were males and 11 were females,with the mean age of(47.9±12.3)years.The primary malignant tumors were lung cancer,breast cancer,leukemia,gastric cancer,ovarian cancer,colon cancer and rectal cancer in 7,2,2,2,1,1,1,respectively.In 26 eyes of ION,20 eyes complained of blurred vision or peripheral vision occlusion and progressive aggravation;no obvious visual symptoms in 6 eyes.BCVA was light sensing to 1.0 with a median of 0.3,including light sensing and light sensing in 4 eyes.Optic disc edema was observed in 19 eyes;no obvious abnormality in 7 eyes.Visual field examination showed that in 22 eyes,normal or mild enlargement of blind spot in 3 eyes,arcuate scotoma in 4 eye

关 键 词：浸润性视神经病变 视乳头水肿 视神经炎 恶性肿瘤 

分 类 号：R739.7[医药卫生—肿瘤] R774.6[医药卫生—临床医学]