前部缺血性视神经病变患者动态血压、心率分析

目的 观察前部缺血性视神经病变(anterior ischemic optic neuropathy,AION)患者24h动态血压、心率变化特征。 方法 分别对AION和与其性别、年龄相匹配的无AION对照组患者各50例进行24 h血压、心率测量，并绘出由夜间（23:00～5:00）到白天（6:00～22:00）的变化曲线。 结果 两组患者之间白天的血压、心率比较差异无显著性意义（P＞0.05），白天血压、心率均高于夜间（t=3.63,3.16; P＜0.05）。夜间AION组血压、心率低于对照组（t=3.82,1.77; P＜0.01,0.05），2:00～7:00血压，尤其舒张压AION组低于对照组（P＜0.01），AION组心率于2:00～5:00低于对照组（女 P＜0.05，男 P＜0.01），夜间到白天的血压上升曲线AION组呈现缓慢的、波动较大的上升曲线，而对照组则为急剧的、平稳的上升曲线。 结论 AION患者存在着对血压调节的某种缺陷；2:00～7:00血压、心率的低点可能是AION发生的易感时段。 (中华眼底病杂志, 2002, 18: 259-261)     

中西医结合治疗前部缺血性视神经病变

前部缺血性视神经病变（anterior ischemic optic neuropathy，AION）是由于后睫状动脉循环障碍，造成视盘供血不足引起的视功能损害。以往主要应用激素、扩血管药物、神经营养药物治疗，疗效不理想。近几年我科应用中西医结合治疗该病18例，取得了较好疗效，现报告如下。     

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％。     

前部缺血性视神经病变38例临床分析

目的：探讨前部缺血性视神经病变的诊断和治疗。方法：本组38例（41只眼）,视力损害严重,视野缺损多与生理盲点相连。眼底视盘边界模糊,水肿、渗出及出血,部分呈现视盘缺血苍白,眼底荧光造影检查;视盘及脉络膜充盈延迟,视盘低荧光。结果;经多种方法治疗视力提高24只眼（58．6％）,21只眼视野扩大,38只眼不同程度视神经萎缩。结论：常规治疗方法效果欠佳,应寻找早期预防、诊断的方法及确切有效的治疗手段。     

前部缺血性视神经病变发病机理探讨

前部缺血性视神经病变发病机理探讨西安市第四医院眼病研究室王润生前部缺血性视神经病变（简称ＡＩＯＮ）的发病机理为睫状动脉灌注压和眼内压之间不平衡所致［１］。我们的前期研究对此已做了讨论［２］。部分病例虽有睫状动脉灌注压和眼内压不平衡，但却未曾发病，这就...     

前部缺血性视神经病变的临床分析

观察分析前部缺血性视神经病变（anterior ischemic optic neuropathy,AION）的发病危险因素、临床特征及治疗效果。 方法：回顾性分析46例51眼AION患者全身及眼部危险因素、临床症状、眼底、FFA、视野改变。治疗和控制全身性疾病,全身或局部应用糖皮质激素、血管扩张剂、神经营养剂,评价治疗效果。 结果：患者平均年龄53±10岁,全身性疾病包括高血压、糖尿病、高脂血症、低血压、心脑血管疾病等。47.06%患者诉视力突然下降,64.71%患者眼底检查示视盘呈灰白色水肿,33.33%患者视野表现偏盲性缺损,56.86%患者FFA早期视盘弱荧光,晚期荧光增强。经治疗80.39%患者视力提高,视野缺损改善。 结论：AION是多病因眼病,高血压、糖尿病、高脂血症、心脑血管疾病等是其发生的危险因素。突然视力下降、视盘灰白水肿、偏盲性视野缺损、FFA视盘早期弱荧光、晚期强荧光是其典型表现。综合治疗后患者可恢复一定视力视野。     

视神经脊髓炎误诊为前部缺血性视神经病变一例

患者女性,69岁。晨起后突然自觉左眼视力下降至光感,并进行性加重。第三天左眼无光感。患者发病前有一周劳累史。既往高血压、冠心病20余年。1993年患风湿性多肌痛。2002年急性左心衰抢救时,右眼曾出现视力下降至无光感,     

糖尿病性视网膜病变患者前部缺血性视神经病变临床分析

目的:了解糖尿病性视网膜病变(diabetic retinopathy,DR)患者群体中,前部缺血性视神经病变(anterior ischemicop-tic neuropathy,AION)的发病情况,进一步探讨AION与糖尿病及DR的可能关系,指导临床诊治。方法:选择需行全视网膜激光光凝治疗的DR患者515例,根据是否同时伴有AION分为AION组(DR合并AION组)和对照组(单纯DR组),行眼部及全身检查,对比分析两组间可能存在的差异。结果:两组患者的性别比例、年龄构成、DR分期无差异,视盘形态、屈光状态、眼内压无差异,血糖、血脂、血压水平无差异。结论:糖尿病可作为AION的独立危险因素,而高血压不是。     

非动脉炎性前部缺血性视神经病变患者血清孕酮水平的变化

目的　观察非动脉炎性前部缺血性视神经病变（ｎｏｎａｒｔｅｒｉｔｉｃａｎｔｅｒｉｏｒｉｓｃｈｅｍｉｃｏｐｔｉｃｎｅｕｒｏｐａｔｈｙ,ＮＡＩＯＮ）患者血清孕酮（ｐｒｏｇｅｓｔｅｒｏｎｅ,ＰＧ）浓度的变化,探讨血清ＰＧ与ＮＡＩＯＮ的关系。方法　将ＮＡＩＯＮ患者４０例作为研究对象,根据病程分为１组（发病１４ｄ内）、２组（＞１４～３０ｄ）、３组（＞３０～６０ｄ）和４组（＞６０～１８０ｄ）;按视盘水肿程度分为重度水肿组、轻度水肿组、水肿消退组。采用化学发光免疫分析法测定ＮＡＩＯＮ患者及年龄相匹配的３０名健康体检者（对照组）的血清ＰＧ水平。统计分析不同性别、病程以及视盘水肿程度的ＮＡＩＯＮ患者与对照组血清ＰＧ水平差异。结果　ＮＡＩＯＮ组较对照组血清ＰＧ水平降低（ｔ＝－４．６８０,Ｐ＜０．０５）。不同性别ＮＡＩＯＮ患者血清ＰＧ水平差异无统计学意义（ｔ＝－０．６４６,Ｐ＞０．０５）。不同病程组间血清ＰＧ水平差异有统计学意义（Ｆ＝１８．９９８,Ｐ＜０．０１）;病程１、２、３组与对照组血清ＰＧ水平比较,差异也均有统计学意义（均为Ｐ＜０．０５）,４组与对照组血清ＰＧ水平比较,差异无统计学意义（Ｐ＞０．０５）。视盘不同水肿程度组间血清ＰＧ水平比较,差异有统计学意义（Ｆ＝１６．７７６,Ｐ＜０．０５）。水肿消退组与对照组血清ＰＧ水平比较,差异无统计学意义（Ｐ＞０．０５）,其余各组间血清ＰＧ水平比较差异均有统计学意义（均为Ｐ＜０．０５）。结论　ＮＡＩＯＮ患者血清ＰＧ水平降低,可能与视盘损害程度相关。     

非动脉炎性前部缺血性视神经病变视野表现分析

目的 观察分析非动脉炎性前部缺血性视神经病变(NAION)视野损伤特征及其影响因素.方法 确诊为NAION并有完整视野检查记录的139例患者纳入研究.其中,男性65例,占46.7%;女性74例,占53.3%.平均发病年龄(56.2±10.8)岁.所有患者均行视力、屈光状态、屈光间质检查,裂隙灯显微镜加前置镜眼底检查、眼底彩色照相、视野检查,其中125例患者进行了荧光素眼底血管造影(FFA)检查,同时行血压、实验室血常规及血生物化学检查.对所有患者的视野表现及其影响因素进行统计学分析;对77只眼的FFA检查结果与视野检查结果一致性进行对比分析.结果 视野检查结果显示,典型下半视野缺损者48只眼,占34.5%;弓形暗点者24只眼,占17.3%;不典型弓形暗点者24只眼,占17.3%;全视野缺损者20只眼,占14.4%;上半视野缺损者10只眼,占7.2%;上半视野缺损+下方弓形暗点者5只眼,占3.6%;下半视野缺损+上方弓形暗点者8只眼,占5.8%.患眼视野平均缺损值(MD值)为-3.0～-32.0,平均MD值为-17.9±7.9.77只眼中,FFA荧光缺损区与视野缺损区非常一致者7只眼,占9.1%;大部分一致者26只眼,占33.8%;小部分一致者39只眼,占50.6%;完全不一致者5只眼,占6.5%.多元线性回归分析结果显示,红细胞平均体积(MCV)(β=0.203,t=2.005)、胆固醇(CHOL)(β=0.230,t=2.244)是影响患眼视野MD值的因素(P＜0.05).结论 NAION视野损害呈现多样化表现;血MCV、CHOL可能是影响视野缺损程度的主要因素.

Abstract：

Objective To study the visual field defects and its correlation factors in nonarteritic anterior ischemic optic neuropathy (NAION). Methods One hundred and thirty-nine patients of NAION with complete visual field examination results were included in this study. There were 65 males (46.7%)and 74 females (53.3%), with an average age of (56.2±10. 8) years. All the patients had undergone the examinations of visual acuity, refraction, refractive media, slit lamp ophthalmoscope, color fundus photography, visual field, blood pressure, blood routine test and blood biochemistry test. Fundus fluorescein angiography (FFA) was carried out in 125 patients. The visual field characteristics and its correlation factors were statistically analyzed, and the FFA and visual field results of 77 eyes were comparatively analyzed. Results The visual field examination showed typical inferior defect in 48 eyes (34. 5%), arcuate scotoma in 24 eyes (17.3%), atypical arcuate scotoma in 24 eyes (17. 3%), defuse defect in 20 eyes ( 14.4% ), superior defect in 10 eyes (7. 2 % ), superior defect with inferior arcuate scotoma in five eyes (3.6 %), inferior defect with superior arcuate scotoma in eight eyes (5.8%). The mean defect (MD) value ranged from -3.0 to -32.0,with an average of - 17.9±7.9. Among 77 eyes with FFA data,the FFA and visual field defect area were highly consistent seven eyes (9. 1%), consistent in 26 eyes (33.8%), some kind of consistent in 39 eyes (50. 6%), completely inconsistent in five eyes (6.5%).Multiple lineal regression analysis showed that mean red cell volume (MCV) (β=0. 203, t= 2. 005) and cholesterol level (CHOL) (β=0. 230, t=2. 244) were correlation factors of MD (P＜0. 05). Conclusion The visual field defect of NAION shows a variety of patterns which may be mainly influenced by MCV and CHOL.     

非动脉炎性前部缺血性视神经病变的治疗进展

非动脉炎性前部缺血性视神经病变(non-arteriti canterior ischemic optic neuropathy,NAION)是中老年人群中最常见的急性视神经病变。目前NAION的病因学和病理生理学机制还不很清楚。大部分有关NAION的治疗研究都是基于回顾性或者前瞻性病例报告研究,疗效很确切的治疗方法尚未见报道。本文就目前的主要治疗方法作一综述。     

Selective thrombophilia screening of patients with nonarteritic anterior ischemic optic neuropathy

Background  To date, the question whether there is a relationship between thrombophilic disorders and the development of nonarteritic ischemic optic neuropathy (NAION) remains controversial. We sought to investigate the prevalence of various coagulation defects among NAION patients <65 years of age, and to provide clinical guidelines for a selective thrombophilia screening. Methods  A cohort of 35 patients <65 years of age with NAION and 70 controls matched for age and sex were prospectively screened for thrombophilic risk factors. Results  Overall, thrombophilic defects were found to be present in 18 of 35 patients (51.4%) and in 12 of 70 (17.1%) controls (P = 0.0005). The most frequent coagulation disorders were increased levels of factor VIII (P = 0.015) and lipoprotein (a) (P = 0.005). Patients without cardiovascular risk factors had a statistically significant higher frequency of coagulation disorders than patients with these risk factors (P = 0.0059). There was a strong association of coagulation disorders and a personal or family history of thromboembolism (P = 0.028). Moreover, we determined the age of ≤55 years at the time of the first thromboembolic event or NAION as a strong predictor of underlying thrombophilia (P = 0.0002). Conclusions  Our results indicate that thrombophilic disorders are associated with the development of NAION in specific subgroups of patients. Selective screening of young patients, subjects with a personal or family history of thromboembolism, and patients without cardiovascular risk factors may be helpful in identifying NAION patients with thrombophilic defects. None of the authors has a proprietary or financial interest in any product mentioned. The corresponding author has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.     

Systemic corticosteroids in nonarteritic ischemic optic neuropathy

Nonarteritic ischemic optic neuropathy (NAION) is one of the most prevalent optic nerve disorders seen in ophthalmic practice. The role of corticosteroid therapy in NAION remains a highly controversial area of debate in ophthalmology. This brief review will provide an overview of the current clinical evidence on this topic as well as some comment on the medical debate.     

Trombophilic screening for nonarteritic anterior ischemic optic neuropathy

Background Nonarteritic anterior ischemic optic neuropathy (NAION) is an ischemic infarction of the optic nerve head, frequently leading to sudden, mostly irreversible loss of vision. In this study blood thrombophilic factors, as well as cardiovascular risk factors were investigated for their relevance to this pathology. Trombophilic risk factors so far not evaluated were included in the study. Patients and methods 37 NAION patients (4 with sequential second eye involvement) and 81 matched control subjects were examined. From blood, protein C, protein S, antithrombin, von Willebrand antigen levels (vWFAg), and factor V (Leiden) mutation, factor VIIIC level, plasminogen activity, lipoprotein (a) and fibrinogen levels, and presence of anticardiolipin antibodies were investigated. Possibly relevant pathologies [e.g. diabetes mellitus (DM), hypertension, and ischemic heart disease] were also registered. Results Elevated Lp(a) and vWFAg levels, DM, F V (Leiden), hypercholesterolemia, and hyperfibinogenemia proved to be significant risk factors associated with NAION. Forward stepwise logistic regression analysis revealed that high Lp(a), DM, and FV (Leiden) were the main predictive components, with odds ratios 16.88 (p=0.012), 5.78 (p=0.022) and 4.44 (p=0.033), respectively. Conclusions Based on our results it appears that thrombophilia is likely to contribute to the development of NAION besides vascular damage due to the presence of cardiovascular risk factors. Further data are needed, however, to justify the suggested use of secondary prophylaxis using anticoagulant/antiplatelet therapy.     

ICGA对NAION与视神经炎的鉴别诊断作用

目的:初步探讨ICGA对非动脉炎性前部缺血型视神经病变与视神经炎鉴别诊断中的作用。方法:临床资料完整的不易确诊视盘水肿患者27例27眼,经眼底照相后,采用视网膜血管和脉络膜血管双项造影检查。同期对年龄性别匹配20例20眼正常对照眼进行造影检查,对脉络膜血管造影的连续图像进行分析和总结。结果:对照眼20例ICGA检查结果显示早期视盘周围脉络膜血管区荧光充盈正常。27眼视盘水肿者接受ICGA检查后,从ICGA造影早期连续图片的表现特点将视盘水肿可明确分为缺血性和非缺血性;缺血性早期连续像表现为一过性的视盘缺血区与脉络膜区域性低荧光相对应,可直接判定缺血范围和缺血程度,随即血管荧光充盈正常,16眼考虑为对非动脉炎性前部缺血型视神经病变,11眼早期连续像表现为视盘周围脉络膜血管区荧光快速充盈,与正常对照眼表现相同,考虑为视神经炎。结论:对一些视盘水肿鉴别诊断存在困惑或疑难时,脉络膜血管造影有一过性视盘脉络膜区域性荧光充盈缺损为非动脉炎性前部缺血型视神经病变的特征性改变,该变化有助于视盘水肿性疾病的鉴别,值得重视。     

非动脉炎性前部缺血性视神经病变视盘形态的Meta分析

目的 采用Meta分析的方法评价非动脉炎性前部缺血性视神经病变（Nonarteritic anterior ischemic optic neuropathy,NAION）患者视盘形态特点。设计 系统综述。研究对象 检索万方全文数据库、EMBASE和Pubmed 数据库中有关NAION 患者视盘定量测量的临床研究文献。方法 依据纳入和排除标准筛选文献,对纳入的研究进行数据提取并进行meta分析,统计学采用Stata软件进行异质性检验、合并WMD和敏感性分析。主要指标 视盘形态学参数。结果 共7篇文献符合纳入标准。NAION患者对侧健眼与正常对照比较,视盘面积（WMD=-0.20,95%CI：-0.37~-0.03）、视杯面积（WMD=-0.36,95%CI：-0.58~-0.14）、杯盘面积比（WMD=-0.15,95%CI：-0.23~-0.06）、视杯容积（WMD=-0.08,95%CI：-0.12~-0.05）、平均视杯深度（WMD=-0.10,95%CI：-0.13~-0.06）、视杯形态测量（WMD=-0.03,95%CI：-0.05~-0.02）均小于正常对照组,差异有统计学意义;而盘沿面积（WMD=0.05,95%CI：-0.15~0.25）、盘沿容积（WMD=0.05,95%CI：-0.07~0.16）两组间差异无统计学意义。NAION患者患眼与对侧健眼比较,盘沿容积（WMD=-0.08,95%CI：-0.14~-0.02）较健眼小,视杯形态测量（WMD=0.03,95%CI：0.00~0.06）较健眼大,差异有统计学意义;视盘面积（WMD=0.08,95%CI：-0.04~0.19）、视杯面积（WMD=0.08,95%CI：-0.01~0.17）、盘沿面积（WMD=-0.05,95%CI：-0.17~0.08）、杯盘面积比（WMD=0.02,95%CI：-0.02~0.06）、视杯容积（WMD=0.01,95%CI：-0.02~0.03）、平均视杯深度（WMD=0.00,95%CI：-0.02~0.03）差异两组间无统计学意义。结论NAION患者具有小视盘、小视杯的特点;NAION发生后,视杯有扩大趋势。（眼科,2014, 23： 235-239）     

双眼非动脉炎性前部缺血性视神经病变的临床特征与危险因素

目的 比较双眼与单眼非动脉炎性前部缺血性视神经病变 （NAION）患者临床特征与危险因素的差异。设计 回顾性病例系列。研究对象 解放军总医院神经眼科2009年10月至2015年3月NAION患者201例。方法 收集患者的病史、实验室检查、颈动脉超声、头颅磁共振（MRI）、多导睡眠监测、24小时动态血压检查结果,并对单眼、双眼患者两组间差异性比较。主要指标 年龄、性别、基础疾病、药物使用、视盘形态。 结果 201例患者中,双眼受累67例（61例双眼同时受累,6例双眼同时发病间隔小于1周）,单眼受累134例。双眼受累组与单眼受累组在年龄（54.69±10.43岁、54.47±9.90岁,P=0.988）、男女比例（1.34:1、2.05:1,P=0.22）方面无明显差异。相比于单眼受累组,双眼受累组患者高血压比例更高（52.2%、37.3%,P=0.04）、夜间睡眠低血压比例更低（19.2%、37.2%,P=0.026）、使用降血压药物更多（65.7%、40.3%,P=0.03）、合并阻塞性睡眠呼吸暂停低通气更多（35.4%、 21.2%,P=0.036）、肥胖比例更大（17.9%、9.7%,P=0.031）。吸烟、饮酒、糖尿病、血脂紊乱、颈动脉粥样硬化、脑梗死、高同型半胱胺酸血症、拥挤视盘、诱发因素等在两组间无明显差异。结论 高血压、使用降血压药物、肥胖及合并睡眠呼吸暂停综合征是发生双眼NAION的危险因素。（眼科, 2016, 25： 377－380）     

非动脉炎性前部缺血性视神经病变的临床治疗现状

非动脉炎性前部缺血性视神经病变（NAION）是50岁以上人群常见的急性视神经病变,以突发、单眼、无痛性视力下降为特征。多种治疗方法被尝试用于治疗NAION,包括药物治疗和手术治疗,但是迄今为止尚无一种治疗方案被证实明确有效。近年的一项非随机前瞻性研究显示,患者急性期口服糖皮质激素可改善视力和视野,减轻视盘水肿,然而其确切疗效仍待证实。对于NAION患者进行的玻璃体腔内注射曲安奈德、抗血管内皮生长因子抗体、促红细胞生成素治疗的试验结果令人鼓舞,然而其所带来的风险不容忽视。目前,NAION的治疗尚缺乏有力的证据,有待更深入的研究,尤其要加强临床前的基础研究。