视网膜疾病误诊球后视神经炎临床特征分析

视神经炎是导致视觉损害的一种常见重要眼病。其中典型性视神经炎与多发性硬化相关联，在急性期大剂量激素冲击有助于加快视力的恢复，并能降低多发性硬化发生的风险。非典型性视神经炎常与中枢神经系统非多发性硬化炎症性疾病有关，该类病人需依靠及时的免疫抑制疗法以促进视力的改善。然而，全身应用大剂量激素或免疫抑制剂，即使在短时间内应用，具有较大毒副作用；此外，视神经炎治疗中有时使用的免疫调节剂如干扰素和免疫球蛋白价格也十分昂贵，因此在治疗前明确球后视神经炎诊断是尤为重要的。由于球后视神经炎患者在发病初期眼底表现正常，临床医生时常将眼底表现正常或有微小改变的视网膜或黄斑疾病误诊为球后视神经炎。在我们临床实践中回顾分析曾被误诊为球后视神经炎的视网膜或黄斑疾病的临床特征及误诊原因，结果发现误诊为视神经疾病的视网膜或黄斑疾病主要病变有急性区域性隐匿性外层视网膜病变、隐匿性黄斑营养不良、视锥和视锥-视杆细胞营养不良、急性黄斑区神经视网膜病变和癌症相关性视网膜病变等，这些疾病与球后视神经炎存在一些相似的临床特征，也是造成误诊的主要原因：单眼或双眼急性或进行性视功能损伤，眼底表现正常或改变轻微，视野和视觉诱发电位异常等。这些视网膜或黄斑疾病往往不需激素或免疫调节剂治疗，当用激素或免疫抑制剂治疗时仅给患者带来全身毒副作用，而无治疗效果。这些疾病的诊断和鉴别主要通过视网膜形态及功能学检查方法进行判断。因此，临床诊疗中，明确球后视神经炎诊断前，进行相关的视网膜形态与功能检查是非常重要的。

Clinical features of retinal diseases masquerading as retrobulbar optic neuritisLibin Jiang1*, Ceying Shen1, Fei Chen1, Weiyu Yan1,2,Timothy Y. Y. Lai3, Ningli Wang1

Purpose: To report and analyze the clinical features of retinal diseases in patients who were misdiagnosed as having retrobulbar optic neuritis (ON).Methods: Retrospective review of 26 patients (38 eyes) who were initially diagnosed to have retrobulbar ON but were ultimately diagnosed to have retinal or macular diseases. Data obtained from fundus examination, fluorescence fundus angiography (FFA), automated static perimetry, full-field electroretinogram (ffERG), multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) were evaluated.Results: A total of 38 eyes of 26 patients were found to have misdiagnosis of retrobulbar ON, based on normal or slight abnormal fundus findings and abnormal visual evoked potentials (VEP). The mean age of the patients was 34.0 years and the correct diagnosis of the patients included acute zonal occult outer retinopathy (AZOOR, 15 eyes, 14 patients), occult macular dystrophy (OMD, 8 eyes, 4 patients), cone or cone-rod dystrophy (10 eyes, 5 patients), acute macular neuroretinopathy (AMNR, 3 eyes, 2 patinets), and cancer-associated retinopathy CAR (2 eyes, 1 patient).Conclusion: When we attempt to diagnose retrobulbar ON in clinical practice, it is crucial to carry out necessary examinations of retinal function and morphology to decrease misdiagnosis.