马来西亚视神经萎缩的临床特点及病因

目的：研究在马来西亚非青光眼视神经萎缩的病因及临床特点。

方法：一系列回顾性的研究分析马来西亚理科大学校医院眼诊所在2007/2011年间被诊断为非青光眼视神经萎缩的患者。至少随访1a。评估这些患者的医疗记录及汇编调查结果。

结果：100例患者符合选择标准，56%的患者双眼都参与研究。主要症状为视力模糊(61%)，除了视力模糊外还出现神经方面病症(18%)，视野狭窄(9%)。大多数患者(63%)患眼视力下降到3/60以下。主要的病因是颅内占位性病变(26%)，先天性疾病(13%)，脑积水(12%)，创伤(12%)及血管因素(12%)。对大多数患者(67%)采用保守治疗。不管其病因，视神经萎缩都伴有不同程度的视功能障碍。随访1a后，50%的患者出现不同程度的视觉障碍。

结论：视神经萎缩主要的病因是颅内占位性病变，其次分别是先天性疾病，创伤和血管疾病。在诊断之前常常就出现视觉和神经上的症状，而疾病显著地影响着视力的变化。为了早期诊断视神经萎缩，当视力模糊的主诉为非特异性时，应该高度怀疑本病。

Clinical profile and aetiology of optic atrophy in Malaysia

AIM:To describe the aetiology and clinical profile of non-glaucomatous optic atrophy in a tertiary hospital in Malaysia.

METHODS: A retrospective case series was conducted on patients diagnosed with non-glaucomatous optic atrophy who presented to the Eye Clinic of Hospital Universiti Sains Malaysia from 2007 until 2011 with a minimum of one year follow-up. Medical records of these patients were reviewed and the findings compiled.

RESULTS: Of the 100 patients who met the selection criteria, 56% had bilateral involvement. The chief presenting symptom was visual blurring(61%), followed by visual blurring with neurological symptoms(18%)and visual field constriction(9%). Most patients(63%)had a presenting visual acuity worse than 3/60 in the affected eye. The main aetiologies were space-occupying intracranial lesions(26%), congenital/hereditary diseases(13%), hydrocephalus(12%), trauma(12%), and vascular causes(12%). The majority of cases(67%)were managed conservatively. Regardless of aetiology, optic atrophy was associated with variable degrees of visual dysfunction. At the end of one year, 50% of the patients had some degree of visual impairment.

CONCLUSION: The main aetiology of optic atrophy was space-occupying intracranial lesions, followed by congenital/hereditary, trauma and vascular problems. Visual or neurological symptoms usually preceded the diagnosis, and visual acuity was significantly affected by the disease. A high level of suspicion is required in order to make an early diagnosis of optic atrophy, as the main complaint of visual blurring is usually non-specific.