视神经疾病的磁共振成像

为探索磁共振成像在视神经萎缩和缺血性视神经病变等视神经疾病的临床应用价值，采用超导型１．５ＴＭＲ机行频谱预饱和反转恢复序列和液体信号衰减反转恢复序列，三方位检查２７例视神经疾病患者。结果：视神经萎缩１７例（３０眼）除３例肿瘤压迫外在ＭＲＩ上均可见视神经异常高信号。缺血性视神经病变５例中４例发病１月后检查发现视神经信号异常，１例第１０天检查未发现异常，同时发现３例有多发脑缺血灶占６０％，２例阴性占４０％。视神经挫伤３例中２例视神经异常信号，且病灶均位于眶尖近管内段处，经皮质内固醇激素治疗后视力均提高，１例未见异常。３例视乳头水肿者中１例仅见视神经异常高信号，为临床误诊，１例为后组筛窦粘液性囊肿（２．２×２×２ｃｍ）压迫所致，另１例ＭＲＩ头部和眼眶视神经均未发现异常，此外２例视乳头水肿临床误诊为视神经炎。结论：ＭＲＩ有助于视神经疾病的诊断和指导临床。     

并发性白内障人工晶体植入术的初步报告

２４例２９只眼并发性白内障囊外摘出联合人工晶体樾主术后随访３个月￣３年（平均１６．４个月），裸眼眼力平均为０．３７１（０．００６￣０．７），≥０．０５者２６只眼（脱盲率８９．６５％）。术后视力较好的是不伴眼后段病变的虹膜睫状体炎并发性白内障，６只眼裸眼视力均≥０．５，平均可达０．６；其次是近视并发性白内障，５０％视力≥０．５；合并视神经视网膜、脉络 及玻璃体病变者效果稍差，但大多（８３．３３％）能     

糖尿病患者白内障囊外摘除与人工晶体植入术疗效分析

在确诊为糖尿病的７４例９０只眼老年性白内障患者，糖尿病年限从１至２１年不等。术前常规检测血糖，使血溏控制在正常或最低水平。患者行囊外摘出加后房型人工晶体植入。晶体为６．５～７ｍｍ直径单凸型。术后３天裸眼视力１．０以上者８只眼（８．９％），０．５～０．９者５７只眼（６３．３％），０．１～０．４者１６只眼（１７．８％），０．１以下者９只眼（１０％）。术中并发症主要有虹膜出血和后囊破裂玻璃体脱出共２眼（２．２％）。术后并发症主要有晶体表面色素沉积（９２％）；晶体表面渗出膜７眼（８％）；术后虹膜后粘连５眼（６％）。糖尿病患者人工晶体植入术多数都能获得满意的结果，但应及时处理术后并发症；对术前血糖不能降至正常的患者，术前应用止血药和抗菌素，术后及时抗炎治疗，同样能恢复良好的视力     

首诊眼科的颅内病变诊断分析

目的 分析颅内病变的眼部表现及诊断方法。方法 分析２２例首诊于眼科的颅内病变的眼部表现及辅助检查，初诊与确诊对照分析。结果 本组中，有视力下降占８１．８％，视野改变占８９．５％，视盘水肿占４０．９％，视神经萎缩占５０％，瞳孔改变占２２．７％，眼肌麻痹占１８．２％，初诊误诊率较高。头颅ＣＴ或ＭＲＩ有助于早期诊断，但较难发现较小病灶。结论 颅内病变可以通过影响视路、瞳孔光反射路及眼运动神经而表现各种眼     

2.8 mm切口超声乳化白内障吸除术的临床观察

探讨２．８ｍｍ透明角膜切口超声乳化白内障吸附折叠式人工晶状植入手术效果。方法对１０５例（１２６只眼）行上述手术患者的术后视力、屈光状态、角膜状态,前房反应、角膜内皮细胞损失率进行回顾性总结。结果术后１ｄ、３ｄ、１周、２或３个月裸眼视力在０．５以上的眼数分别为１０２只眼（８１．０％）,１０８只眼（８５．７％）、１１２只眼（８８．９％）及１１２只眼（８８．９％）;术后３ｄ、１周、１个月、３个月平均散光     

前部缺血性视神经病变

回顾性总结５１例前部缺血性视神经病变。５１例中单眼发病４４例；双眼７例（１３．７％），其中５例对侧眼已有视神经萎缩。平均发病年龄５４．９岁。作为病因的系统疾病，动脉粥样硬化占５４．９％，高血压动脉硬化３３．３％，糖尿病１１．８％。视力中度损害（０．２—０．５）者占１／３。下部视野缺损占３０．２％，大多与生理盲点相连；４只眼各有两处视野缺损。荧光血管造影揭示，脉络膜（含视盘）视网膜充盈倒置占２１．１％；视盘充盈延迟苍白水肿及火焰状出血表明前部视神经（筛板附近）的睫状后短动脉及表浅的中央血管微血管发生缺血损害。经药物治疗视力进步者占７５．８％。     

高度近视合并白内障超声乳化及负,低度数人工晶体植入术

目的探讨高度近视合并白内障超声乳化及负、低度数人工晶体植入术的临床疗效。方法总计１０２例（１２０只眼）眼轴长≥２８ｍｍ的高度近视合并白内障患者,其中Ⅱ级核５只眼,Ⅲ级核８４只眼,Ⅳ级核１６只眼,Ⅴ级核１５只眼。采用巩膜隧道式切口及原位超声乳化碎核,超声能量设定Ⅱ或Ⅲ级核为５０％～６０％,超声时间４０～１３０秒,平均７１．３秒。Ⅳ或Ⅴ级核采用超声乳化中央切核和手法出核,超声能量设定为６５％～７０％,超声时间４８～８２秒,平均６８．７秒。结果术后１个月裸眼视力≥０．５者５２只眼（４３．４％）,矫正视力≥０．５者７５只眼（６２．６％）。术后随访１１～２２个月,平均１４．５个月。手术主要并发症为角膜水肿（６．７％）和后囊膜破裂（４．２％）。未见视网膜脱离及黄斑囊样水肿。结论超声乳化联合负、低度数人工晶体植入适合于高度近视合并白内障患者,具有恢复良好视功能、矫正屈光不正、预防视网膜脱离、减少后发障及手术并发症等优点,值得临床推广应用     

晶体核切开法白内障囊外摘除人工晶体植入术临床探讨

采用晶体核切开法，在６ｍｍ切口下对５３例５６眼白内障施行白内障囊外摘除ＰＭＭＡ后房型人工晶体植入术，结果术后１周，１月，３月，裸眼视力≥４．７者分别为：３５眼（６２．５％），４９眼（８７．５％）５３眼（９４．６％），平均术后角膜散光度分别为：１．５５Ｄ（ｓ：１．２２），１．１１Ｄ（ｓ：０．９７），０．８７Ｄ（ｓ：０．７５）均较同期１０ｍｍ切口常规手术对照组为低（Ｐ〈０．００１）。本文还手术操作技巧     

无缝线切口二期后房型人工晶状体植入术疗效观察

目的评价无缝线切口二期后房型人工晶状体植入术的疗效。方法对 ２２眼无晶状体眼患者分别采用３．５ ｍｍ（Ａ组 １０眼）及 ５．５ ｍｍ（Ｂ组 １２眼）的反眉状巩膜隧道切口，二期植入 ６ ｍｍ折叠式丙烯酸脂类及一体式 ＰＭＭＡ后房型人工晶状体，并与同期 １２眼６ ｍｍ常规角膜缘切口（Ｃ组），二期 ６ ｍｍ一体式 ＰＭＭＡ后房型人工晶状体植人对比。结果随访 ３～１５个月，无缝线切口组术后矫正视力均优于及等于术前最佳矫正视力，其中≥０．５者 Ａ组 ９眼（９０％），Ｂ组 ９眼（７５％）。缝线切口组，术后矫正视力优于及等于术前最佳矫正视力１０眼（８３． ５％）， ≥０．５者７眼（５８．３％）。结论采用无缝线切口二期后房型人工晶状体植人可明显降低角膜散光，减轻术后炎症反应及增加手术的安全性，是矫正无晶状体眼屈光不正的一种较理想的方法。     

高度近视白内障超声乳化摘除术

分析５４例（７５只眼）高度近视白内障超声乳化摘除术的疗效。本组平均眼轴长２９．０３±２．６４ｍｍ（２６．１２～３４．３９ｍｍ），人工晶体植入组平均眼轴长２８．１６±１．９７ｍｍ，非人工晶体植入组平均眼轴长３０．８２±２．０３ｍｍ。平均随访１６．５个月。术后矫正视力≥０．５者占６１．３％，脱盲率为９４．７％，脱残率为７８．７％。影响术后视力主要原因为高度近视所致眼底病变，后囊膜破裂是造成术后视网膜脱离最危险因素。     

MRI lesions of the optic nerves in optic neuritis

Magnetic resonance imaging (MRI) was performed in 14 patients with optic neuritis. Three patients suffered from multiple sclerosis but the etiologies of the remaining 11 cases could not be identified. They were bilateral in 6, and unilateral in 8. The MR images were compared with the symptomatic lesions of optic neuritis and pattern reversal VECP. The STIR mode (short time inversion recovery), was employed for the MRI in the orbit and T2-weighted mode in the brain. In 11 eyes with hyperemia of the optic disc, 7 eyes showed a high signal in the optic nerve with the MRI, and 9 eyes showed an abnormal pattern VECP. Seven eyes with normal disc and two eyes with a pale disc showed a high signal in the optic nerve with MRI, those 9 eyes had abnormal pattern VECP. The high signal in the optic nerve was not related to visual acuity or visual field abnormalities of patients. However, the degree of the high signal of the optic nerve lesion in MRI was associated with the clinical course and prognosis of the optic neuritis. The degree of the high signal of the optic nerve lesion decreased with the recovery of visual acuity in optic neuritis.     

Pattern visually evoked cortical potential and magnetic resonance imaging in optic neuritis.

We studied the extent of optic nerve lesion with magnetic resonance imaging (MRI) in 24 patients with optic neuritis and compared it with visually evoked cortical potentials (VECP). Patients were divided into acute and chronic stage groups according to the duration of the disease from its onset. The short TI inversion recovery (STIR) mode of the MRI was selected for study. In the acute stage group, abnormally high signals of optic nerve on MRI were demonstrated in 11 of 12 eyes, and the amplitude and peak latency of pattern VECP were unrelated to the extent of the optic nerve lesion visualized by MRI. Conversely, in the chronic stage group, the abnormal MRI findings were exhibited in 19 of 23 eyes, and the relationship between the measurements was statistically significant. This difference in the optic nerve lesion observed by MRI between the acute stage and the chronic stage of optic neuritis may indicate pathophysiologic differences in their origins.     

儿童视神经炎病因分析

目的 了解临床初诊为视神经炎（ON）儿童患者的病因分布和临床特点。 方法 收集158例初诊ON的儿童患者详细的眼科和神经内科检查及实验室、影像学检查资料, 参照国际认可的标准重新诊断，并与成人ON病因进行比较 。 结果 104例初诊为ON的儿童患者最后诊断符合ON，占65.8%。其中，80例为特发性脱髓鞘性ON，占76.9%；感染性ON和炎性视神经病各3例，18例病因 未明。另54例不符合ON诊断，其中，以Leber遗传性视神经病、非器质性视力下降等较常见。 结论 初诊为ON的儿童患者病因分布与成人类似，以特发性脱髓鞘性ON最为常见。Leber遗传性视神经病和非器质性视力下降是儿童患者中最常见的与 ON混淆的疾病。 (中华眼底病杂志，2008，24：95-98)     

伴近视的鞍区肿瘤眼部病变特点

目的：探讨近视患者的鞍区肿瘤眼部病变的临床特点。方法：回顾分析了18例伴近视的鞍区肿瘤的视力、视野及眼底等情况。结果：18例初诊时,19眼（占52.8%）视力低下4.0,仅5例（占27.8%）视野缺损呈典型的视交性单、双颞侧偏盲,10例（占55.6%）双眼视神经不同程度萎缩,4例（占22.2%）单眼视神经萎缩。结论：伴近视的鞍区肿瘤眼部病变常很严重,容易被误诊为青光眼性视神经萎缩,视乳头炎、缺血性视神经病变。     

以急性视神经炎首发的多发性硬化视神经功能障碍分析

目的 探讨以急性视神经炎(acute optic neuritis,AON)为首发的多发性硬化(multiple sclerosis,MS)视神经功能的改变特点,及时治疗并尽大可能恢复视神经功能.方法 对每例以视神经炎为首发的MS患者行视力、眼底、视野及视诱发电位检查,部分患者行CT或者MRI,脑脊液测定和寡克隆区带检查.采用χ2检验与t检验对患者视神经功能改变的特点进行分析.结果 (1)视神经功能检查:所有患者均有视力下降;不同程度的视神经萎缩、视神经乳头水肿表现;客观检查显示视野损害、视诱发电位、色觉异常;与无伴AON的MS患者进行比较,在视力下降及视神经乳头水肿方面差异均有统计学意义;视诱发电位检查均存在异常,表现在P100潜伏期延长,AON组异常率为63.6%～72.7%,无伴AON的MS组为21.4%～28.5%,两组相比差异有显著性意义(P＜0.05).(2)脑脊液免疫球蛋白检查:视神经炎鞘内IgG合成率低于无伴AON组(P＜0.01).(3)所有患者经大剂量肾上腺素糖皮质激素及时治疗后,视力恢复到0.5以上者约31.2%～36.3%.结论 AON是MS的最常见症状之一,视神经炎与MS视神经脊髓炎型的视神经损害发生频率高且程度重,迫切需要对AON患者进行早期诊断,并及时给予大剂量肾上腺素糖皮质激素治疗.     

Clinical Features of Optic Neuritis in China

Objective: To document the clinical features of optic neuritis in a population of China and compare with reports of Western countries. Background: Optic neuritis is a common optic neuropathy well studied in Western countries. In English literature very few studies addressed optic neuritis in China. Method: Retrospective medical chart review of all patients admitted in a teaching hospital from 2002 to 2005 with a final diagnosis of idiopathic demyelinating optic neuritis. Results: Ninety-eight patients including 45 men and 53 women were collected, with a mean age of 25.7 years. Sixty-six cases (67.3%) were unilateral optic neuritis and 32 (32.7%) were bilateral. Eye pain was reported in 42 cases (42.9%). Visual acuity in 130 affected eyes varied from 0.8 to no light perception, with 0.1 or worse in 101(77.7%), between 0.1 and 0.4 in 15 (11.5%) and 0.5 or better in 14(10.8%). Fifty-two eyes (40%) showed disc swelling. Central scotoma was the most common (61%) localized visual field defect. Optic nerve enhancement was found in 85 of 121 eyes (70.2%) while 15 cases (15.3%) showed periventricular plaques in brain MRI. Positive oligoclonal band or elevated myelin basic protein was found in 17 (17.3%) cases. Eight (8.2%) cases met the criteria of clinical definite multiple sclerosis and 4 cases had neuromyelitis optica. Visual acuity of 35 eyes (26.9%) improved to 1.0 or better while 37 eyes (28.5%) remained 0.1 or worse at the 3-month follow-up. Conclusion: Clinical features of optic neuritis in a population of China were documented. Less ocular pain, less brain MRI abnormalities, more severe visual loss and poor visual outcome were seen compared to reports of Western countries.     

多发性硬化患者发生视神经炎34例的回顾性分析

目的:探讨视神经炎与多发性硬化(multiple sclerosis,MS)的相互关系,评价甲基强的松龙对多发性硬化的治疗效果。方法:回顾性分析解放军总医院2000/2005年多发性硬化住院患者85例,所有患者均符合Poser诊断标准,用SPSS软件统计并分析这些患者的临床资料。结果:在85例患者中,出现视神经炎36例(42%),其中20例(24%)以视神经炎为首发症状。对所有辅助检查结果分析后发现,有视神经炎患者头部MRI的异常数(64%)高于无眼部症状患者组(30%)(P<0.05,χ2=6.28);有视神经炎患者颈部MRI的异常数(64%)高于无眼部症状患者组(31%)(P<0.05,χ2=4.87)。经过大剂量甲强龙冲击并丙种球蛋白辅助治疗有59例(69%)症状缓解,18例(21%)病情减轻,有视神经炎36例患者31例视力有所提高。结论:对于首发视力障碍就诊于眼科、诊断为视神经炎的患者,应常规行MRI检查以除外MS,大剂量甲强龙冲击并干扰素或丙种球蛋白辅助治疗是MS首选方式。     

多发性硬化症眼科误诊的临床分析

目的:分析以单眼视神经受损为首发症状的多发性硬化症的临床特点,探讨误诊原因。方法:对3例诊断为视神经炎及球后视神经炎,给予详细的眼科检查、VEP检查及颅脑MRI检查。结果:通过眼部检查、相关辅助检查及颅脑磁共振检查最后确诊3例单眼视神经受损的患者均为多发性硬化症。结论:多发性硬化症若以视神经受累为首发症状而无全身其他症状时,容易诊断为单纯性视神经炎而漏诊。     

Neutron spin tomography of the optic nerve in retrobulbar neuritis and optic nerve atrophy: demonstration of inflammation and demyelination

Detection of inflammatory lesions of the optic nerve by magnetic resonance imaging requires a special imaging technique. In 3 patients with persisting visual loss due to retrobulbar neuritis we scanned the optic nerve with a short inversion recovery sequence. In each of the 3 patients magnetic resonance imaging revealed inflammatory lesions in the intracanalicular portion of the optic nerve. It is supposed that the unfavorable location of the lesions in the optic canal is responsible for the poor recovery of visual acuity. In another patient with a bilateral optic nerve atrophy demyelination of the optic nerve could be made visible.     

Clinical characteristics of multiple sclerosis and associated optic neuritis in Korean children

PURPOSE: To study the clinical characteristics of multiple sclerosis and associated optic neuritis in Korean children. METHOD: A retrospective analysis was performed on 10 patients with an onset of multiple sclerosis before age 16. Information on sex, age of onset, clinical course, laboratory findings, and clinical characteristics of optic neuritis was obtained. RESULT: The mean age at presentation was 7.31 +/- 2.99 years, and the mean duration of observation was 36.2 +/- 26.1 months. No female predilection (50%) was observed. The disease presented as relapsing-remitting type multiple sclerosis in all patients and transited to secondary progressive type in two cases (20%). No oligoclonal bands were found in any patient. Optic neuritis occurred in eight patients (80%); five (62.5%) of these had optic neuritis at the first multiple sclerosis attack, with all five manifesting bilateral simultaneous optic neuritis. Visual acuity recovered to > or =20/40 in 8 of 15 eyes (53.3%), but in 2 eyes (13.3%) visual acuity remained at < or =20/200. In the patients with optic neuritis, the patients who showed optic neuritis at initial presentation had a worse visual prognosis (p = 0.030, Mann-Whitney U-test). CONCLUSIONS: In Korean children with multiple sclerosis, age of onset was younger than reported in other countries, and there was no female predominance. The prognosis for good visual acuity was worse in patients who initially presented with optic neuritis.