筛板前视神经炎临床特征分析  

Clinical features of prelaminar optic neuritis

作　　者：贾庆霞 杨庆林[1] 王佳伟[1] Jia Qingxia;Yang Qinglin;Wang Jiawei(Department of Neurology,Beijing Tongren Hospital,Capital Medical Unirersity,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院神经内科,北京100730

出　　处：《眼科》2024年第2期140-144,共5页Ophthalmology in China

摘　　要：目的总结筛板前视神经炎的临床特点、治疗及转归。设计回顾性病例系列。研究对象2019年1月至2023年6月北京同仁医院神经内科筛板前视神经炎患者18例。方法回顾患者的一般资料、既往病史、临床表现、检查结果,包括视力、视野、眼底像、视觉诱发电位(VEP)、脑脊液寡克隆区带(OB)、中枢神经脱髓鞘抗体等,以及治疗方式和视力转归,总结其临床特征主要指标病情达峰时及发病后3个月最佳矫正视力(BCVA)、视野缺损特点、视盘水肿程度、有无盘周出血、VEP中P100潜伏期及波幅、中枢神经脱髓鞘抗体结果、脑脊液OB是否阳性、治疗方案。结果18例患者中女性13例,平均发病年龄(43.61±2.94)岁。20眼受累,其中病情达峰时BCVA≤0.1者9眼(45%),≥0.5者8眼(40%)。8眼(40%)弥漫性视野缺损,6眼(30%)不规则片状视野缺损,3眼(15%)中心暗点:10眼(50%)中重度视盘水肿,7眼(35%)伴有盘周出血。16眼(80%)VEP仅存在P100潜伏期延长,4眼(20%)存在潜伏期延长合并波幅减低。18例患者中脑脊液0B阳性者3例(16.7%),髓鞘少突胶质细胞糖蛋白(MOG)抗体阳性4例(22.2%),阴性11例(61.1%)3例患者接受口服醋酸泼尼松治疗.15例患者接受大剂量甲强龙静脉冲击治疗,所有患者均未使用免疫抑制剂。20眼中11眼(55%)发病3个月视力明显改善或完全恢复,8眼(40%)视力有所改善,仪有2眼(10%)视力无变化。结论筛板前视神经炎视力损害轻重不一,弥漫性视野缺损和重度视盘水肿更多见,经糖皮质激素治疗后视功能恢复较好。Objective To summarize the clinical features.,treatment and outcome of prelaminar optic neuritis patients.Design Retrospective case series.Participants A total of 18 patients with prelaminar optic neuritis who were hospitalized in the Department of Neurology of Beijing Tongren Hospital from January 2019 to June 2023 were ineluded.Methods The demographic data.past medical history.clinical manifestations.ancillary test results,including visual acuity.,visual field,fundus photographs.visual evoked potential(VEP),oligoclonal bands(OB)in cerebrospinal fluid.central nervous system demyelination antibodies,treatment options and visual prognosis of the patients were collected.Main Outcome Measures Best corrected visual acuity(BCVA)at the acute stage of the dis-ease and 3 months after onset.patterns of visual field defects.degrees of optic disc edema.with or without peridisc hemorrhage.laten-cies and amplitudes of P100.demyelinating antibodies,OB in cerebrospinal fluid.treatment options.Results Among the 18 patients with prelaminar optic neuritis.13 were females.with an average age of(43.61±2.94)years at onset.There were 20 affected eyes.of which 9 eyes(45%)had BCVA≤0.1 at the worst stage of the disease and 8 eyes(40%)had BCVA≥0.5.Diffuse visual field defects oc-curred in 8 eyes(40%).irregular patchy visual field defects in 6 eyes(30%).and central scotomas in 3 eyes(15%).Moderate to severe optic disc edema were seen in 10 eyes(50%),and peridisc hemorrhage in 7 eyes(35%).Only the P100 latency was prolonged in 16 eyes(80%).and prolonged latency with decreased amplitudes in 4 eyes(20%).There were 3 cases(16.7%)with positive 0B in cere-brospinal fluids.4 cases(22.2%)with positive MOG antibody in serum.and negative for biomarkers in other 11 cases(61.1%).Three patients received oral prednisone acetate tablets and 15 patients received intravenous high-dose methylprednisolone.and no patients re-ceived immunosuppressants.Eleven eyes(55%)showed significant improvement or complete recovery in visual acuity at 3 months.8 eyes(4

关 键 词：筛板前视神经炎 视神经炎 

分 类 号：R774.61[医药卫生—眼科]