放射性视神经病变的临床分析

目的探讨放射性视神经病变（RON）的临床特征及治疗。方法回顾分析1987至2008年我院27例经病史询问、眼底检查、视野、荧光素眼底血管造影（FFA）、B超、核磁共振（MRI）等检查确诊的27例（29只眼）RON患者的临床资料。结果所有病例接受的照射剂量均超过4500厘戈瑞（cGY）。所有病例均表现为单眼或双眼无痛性视力急剧下降。29只眼中,17只眼视乳头外观正常,8只眼苍白色视乳头水肿,1只眼视乳头完全萎缩,1只眼表现为视乳头颞侧苍白。23只眼的FFA显示视乳头及视网膜毛血管无灌注,7只眼在MRI检查时显示视神经或视交叉节段性增大。分别用高压氧、高压氧加光量子照射自血回输、复方樟柳碱治疗,7只眼无效,其余眼视力均有不同程度的改善。结论 RON的发生与肿瘤的部位及照射剂量有关。RON的独特临床表现可为临床及时诊断提供客观依据。诊断一旦确立,可采用高压氧、高压氧加光量子照射自血回输、复方樟柳碱治疗,治疗越早,效果越好。     

放射性视神经病变

放射性视神经病变解放军９５医院眼科盛天金解放军总医院眼科魏世辉，宋琛放射性视神经病变（ｒａｄｉａｔｉｏｎｏｐｔｉｃｎｅｕｒｏｐａｔｈｙ，简称ＲＯＮ）作为头部肿瘤放射治疗的一种并发症自１９３３年Ｓｔａｌｌａｒｄ［１］首次报导以来，国外陆续见有报导，且越...     

放射性视神经病变

本文对１２例１４只眼的放射性视神经病变作了报导。并就放射性视神经病变的诊断要点作了介绍。文章认为高压氧加光量子照射自血回输是治疗放射性视神经病变的最佳治疗方法。     

复方樟柳碱治疗放射性视神经病变

复方樟柳碱治疗放射性视神经病变中国人民解放军总医院眼科魏世辉福建莆田解放军９５医院眼科盛天金放射性视神经病变（Ｒａｄｉａｔｉｏｎｏｐｔｉｃｎｅｕｒｏｐａｔｈｙ，ＲＯＮ）是头部肿瘤放射治疗的一种眼部并发症。自１９３３年Ｓｔａｌｌａｒｄ［１］首次报道以来...     

放射性视神经病变研究进展

放射性视神经病变(RON)是因邻近视路的头颈部放射治疗(放疗)而引起的迟发性进行性视神经并发症.临床表现以突发的、无痛性单眼或双眼视力进行性下降为主要特征.视路接受的照射剂量及照射范围是发生RON的关键因素.增强的核磁共振成像(MRI检查以及电生理检测具有一定的辅助诊断意义;结合其临床表现、相应辅助检查及头颈部放疗史可作出诊断.虽然高压氧治疗能在发病早期一定程度上改善RON的视力损害,但目前仍然缺乏行之有效的治疗方法.因此,在制定头颈部放疗计划时应充分考虑视神经、视交叉是否在照射范围内,并注意控制照射剂量,以防止RON的发生.     

放射性视神经病变

放射性视神经病变(RON)是由头部、眶部或鼻腔肿瘤放射治疗引起的严重眼部并发症.RON造成的视功能损害常不可逆,严重者可完全失明,目前尚无有效疗法.对涉及该领域的文献进行整理归纳,从发病、病理机制、临床表现、辅助检查、鉴别诊断、治疗及预防等方面对该病进行论述,以此引起临床医生对该病的关注以便及时发现本病,采取合理的放疗方案以预防RON的发生.     

迟发性放射性视神经病变

放射性视神经病变（ＲＯＮ）是一种由头部肿瘤放射治疗引起的眼部并发症。其临床表现为单眼或双眼先后出现视力急剧下降以至失明。损害前部视神经可有视盘水肿、视盘周围出血、硬性渗同、棉絮状斑；损害后部视神经眼底正常或视盘颜色变淡。视野改变为大中心暗点、旁中心暗点、扇形、象限性或双颞侧视野缺损。眼底荧光素血管造影为视盘上或视网膜内毛细血管无灌注区。发病时间为放疗后４个月至３年内，故称之为迟发性。复发樟柳碱     

放射性视神经病变的诊断及复方樟柳碱治疗

放射性视神经病变的诊断及复方樟柳碱治疗福建莆田解放军９５医院眼科盛天金北京市解放军总医院眼科魏世辉放射性视神经病变（ｒａｄｉａｔｉｏｎｏｐｔｉｃｎｅｕｒｏＰａｔｈｙ，ＲＯＮ）作为头部肿瘤放射治疗的一种眼部并发症自１９３３年ｓｔａｌｌａｒｄｌ＇ｌ首次报...     

与肿瘤相关的视神经病变

与肿瘤相关的视神经病变是一组少见的神经眼科疾病谱,国内外仅有少量个案或小样本的文献报道,目前尚未见关于该疾病谱的综合报道。该组疾病因病种不同临床表现各异,早期诊断并且选择恰当的个体化精准治疗往往可以挽救患者的视力甚至生命。然而,由于眼科医师对该组疾病的认识不足,临床上经常出现误诊或漏诊。本文结合文献及笔者所在的解放军总医院神经眼科团队的经验,首次对该疾病谱的病因、临床特征、诊断及鉴别、治疗及预后加以梳理归纳。     

农药中毒致视神经病变的临床分析

农药中毒在临床上屡见不鲜，但中毒引起视神经病变的比较罕见，笔者遇到2例，结合临床现分析报告如下。     

Etanercept associated optic neuropathy

We report the case of a 14-year-old boy who developed optic neuropathy subsequent to the use of etanercept. There have been 15 reported cases of anti-TNF-alpha-associated optic neuropathy to date and their characteristics are reviewed in this report, as well as possible pathophysiologic mechanisms behind such phenomenon. Such cases demonstrate the importance of prompt ophthalmologic evaluation of visual changes in patients being treated with anti-TNF-alpha antagonists.     

Diameter of the optic nerve in idiopathic optic neuritis and in anterior ischemic optic neuropathy

Purpose: There is considerable overlap in the clinical profile of patients with idiopathic optic neuritis(ON) and anterior ischemic optic neuropathy (AION). We tested the hypothesis that the retrobulbar diameter of the optic nerve may be a criterion for the differential diagnosis between ON and AION. Methods: The diameter of the optic nerve was measured by B-scan ultrasonography with the eye in an abducted position. Only patients with a unilateral optic neuropathy were included, 16 ON patients (mean age 24years, 5 with and 11 without disc swelling) and 9patients with AION (mean age 72 years). As controls for the ON patients 10 young normal subjects (mean age25 years) and as controls for the AION patients 10elderly subjects with eye problems not related to the optic nerve (mean age 76 years) were examined. Results: In the ON patients with disc swelling the diameter of the optic nerve was 5.4 ± 0.5 mm in the affected and 3.0 ± 0.3 mm in the unaffected side. This difference was significant (Wilcoxon-test, p = 0.043). In the ON patients without disc swelling the diameter of the optic nerve was 4.4 ± 0.4 mm in the affected and 3.0 ± 0.3 mm in the unaffected side. This difference was significant (Wilcoxon-test, p = 0.003). In the AION patients the diameter of the optic nerve was 3.0 ± 0.3 mm on the affected and2.8 ± 0.4 mm on the unaffected side. This difference was not significant (Wilcoxon-test, p =0.093). Comparing the optic nerves with ON and AION to those of the controls, the diameter was significantly enlarged in the nerves with ON and normal in the nerves with AION (one factor repeated ANOVA). Conclusion: The diameter of the optic nerve is increased in ON without disc swelling and even more so in ON with disc swelling. The enlargement is probably due to edema of the nerve itself, not the surrounding subarachnoidal space. In AION, the diameter of the optic nerve is normal. Measuring the diameter of the optic nerve by B-scan ultrasonography is particularly useful in the differential diagnosis between ON with disc swelling and AION. This revised version was published online in August 2006 with corrections to the Cover Date.     

Multifocal visual evoked potential in optic neuritis,ischemic optic neuropathy and compressive optic neuropathy

Purpose:

To investigate the effect of optic neuritis (ON), ischemic optic neuropathy (ION) and compressive optic neuropathy (CON) on multifocal visual evoked potential (mfVEP) amplitudes and latencies, and to compare the parameters among three optic nerve disorders.

Materials and Methods:

mfVEP was recorded for 71 eyes of controls and 48 eyes of optic nerve disorders with subgroups of optic neuritis (ON, n = 21 eyes), ischemic optic neuropathy (ION, n = 14 eyes), and compressive optic neuropathy (CON, n = 13 eyes). The size of defect in mfVEP amplitude probability plots and relative latency plots were analyzed. The pattern of the defect in amplitude probability plot was classified according to the visual field profile of optic neuritis treatment trail (ONTT).

Results:

Median of mfVEP amplitude (log SNR) averaged across 60 sectors were reduced in ON (0.17 (0.13-0.33)), ION (0.14 (0.12-0.21)) and CON (0.21 (0.14-0.30)) when compared to controls. The median mfVEP relative latencies compared to controls were significantly prolonged in ON and CON group of 10.53 (2.62-15.50) ms and 5.73 (2.67-14.14) ms respectively compared to ION group (2.06 (-4.09-13.02)). The common mfVEP amplitude defects observed in probability plots were diffuse pattern in ON, inferior altitudinal defect in ION and temporal hemianopia in CON eyes.

Conclusions:

Optic nerve disorders cause reduction in mfVEP amplitudes. The extent of delayed latency noted in ischemic optic neuropathy was significantly lesser compared to subjects with optic neuritis and compressive optic neuropathy. mfVEP amplitudes can be used to objectively assess the topography of the visual field defect.     

双眼非动脉炎性前部缺血性视神经病变患者的临床特点和预后分析

目的：研究双眼非动脉炎性前部缺血性视神经病变(nonarteritic ischemic optic neuropathy, NAION)患者的临床特点及其预后的影响因素。

方法：回顾2006年以来我院收治的双眼发病NAION患者的临床资料,包括发病特点、治疗方法、人口统计学特征、病史、视功能指标(视力、视野)等,并对影响视功能预后的相关因素进行统计分析。

结果：研究共纳入61例(122眼)双眼NAION患者,其中男性39例,女性22例,平均年龄58.0±11.0岁,就诊时平均病程12.5mo(IQR 4.75～26.5),初诊时最佳矫正视力中位数为0.7 LogMAR(IQR 0.2～1.3)。就诊时38眼仍有不同程度视盘水肿,76眼视盘色淡或苍白。典型的视野缺损类型分别为下方近水平半盲(38眼)、鼻上方缺损(21眼)、鼻下方缺损(16眼)、上方近水平半盲(13眼),以及近管状视野(12眼)。纳入患者中31例伴有高血压、高血脂、糖尿病或其他心脑血管疾病。患者随访时间的中位数为12mo(IQR 6.0～23.5),随访期间视力中位数由0.7 LogMAR(IQR 0.2～1.3)提高至0.4 LogMAR(IQR 0.175～1.1),其中45眼(36.9%)的视力提高了2行或以上。男性患者和女性患者的视力比较,初诊时及随访后两者均无统计学差异(Z=-0.521,-1.600,P>0.05)。伴有心脑血管疾病的患者与不伴心脑血管疾病者比较,初诊时两组患者视力无统计学差异(Z=-1.103,P>0.05),但末次随访时不伴有心脑血管疾病的患者的视力明显优于伴心脑血管疾病的患者(Z=-2.090,P<0.05)。首发眼和后发病眼的末次随访视力均优于初诊视力(P=0.003,0.019),且首发眼的视力在随访期间的提高幅度高于后发病眼的视力提高幅度(分别为0.2 LogMAR及0.1 LogMAR),但差异尚无统计学意义(P=0.195)。

结论：本研究统计分析了双眼NAION患者的人口统计学特征、发病率、病史、视功能指标(视力、视野)等,现有随访数据表明,不伴心脑血管疾病的双眼NAION患者视力改善幅度优于患心脑血管疾病者,且首发眼视力预后可能优于后发病眼。但目前尚缺乏足够证据,仍需进一步研究。     

视觉诱发电位在视神经病变诊断中的作用

目的 探讨视觉诱发电位在初诊为视神经炎的急性视力下降患者病因诊断中的应用价值。设计 回顾性病例系 列。研究对象 66例(115眼)初诊为视神经炎的急性视力下降患者。方法 比较66例不同病因急性视力下降患者的图形翻转 视觉诱发电位(P-VEP)异常。主要指标 视觉诱发电位P100潜伏期和振幅。结果 P-VEP在特发性脱髓鞘性视神经炎 (IDON)、其他类型视神经炎、缺血性视神经病和压迫性视神经病中异常率分别为89．7％、93．7％、100．0％和60．0％;颅内疾病导 致的视盘水肿、心因性视力下降和原田氏病未发现VEP异常。P-VEP潜伏期延长在IDON、其他类型视神经炎、缺血性视神经病 分别为64．1％、62．5％和16．7％。P-VEP振幅下降在该三组则分别为30．7％、68．7％和83．3％。IDON组P-VEP潜伏期(152．0ms± 18．5ms)与其他类型视神经炎组(136．0ms±20．2ms)相比有显著性差异(t=3．603,P=0．01)。结论 P-VEP有助于急性视力下降 患者的病因诊断,并对鉴别不同病因的视神经病变有一定帮助。     

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的电生理及临床特征分析

目的：对NAION患者的电生理及临床特征进行分析。

方法：选取本院2015-06/2016-06收治的68例81眼非动脉炎性前部缺血性视神经病变(non-arteritic anterior ischaemic optic neuropathy,NAION)患者作为研究对象,按照年龄分为对照组36例39眼(平均年龄50岁以下),观察组32例42眼(平均年龄50岁以上)。对两组患者的人口学特点、临床特点、相关危险因素、图形视觉诱发电位、视力等方面进行对比分析。

结果：对照组患者临床症状中,发病时有遮挡感、对侧眼受累比例均明显低于观察组患者,组间差异有统计学意义(P<0.05)。对照组患者1°空间频率和15''空间频率均明显优于观察组,组间差异有统计学意义(P<0.05)。对照组与观察组患者初始视力比较,差异无统计学意义(P>0.05)。对照组患者最终视力明显优于观察组患者,组间差异有统计学意义(P<0.05)。

结论：患有NAION的患者,其临床病症受年龄较大、发病时有遮挡感、对侧眼受累等因素影响,1°空间频率和15''空间频率延迟相对较严重,且最终视力并不十分良好。由此可见,对NAION患者进行电生理检查有助于进行病情的诊断,临床亦应该加强对NAION患者的随访,减少其患眼对侧眼的发病几率。     

Intravenous immunoglobulin in recurrent-relapsing inflammatory optic neuropathy

Objective: Recurrent-relapsing inflammatory optic neuropathy, including chronic relapsing inflammatory and autoimmune optic neuropathies, is rare, but can cause severe visual loss. Long-term steroids may preserve vision, yet side effects are frequent. We describe our experience with intravenous immunoglobulins (IVIg).Design: A semi-prospective case series from 4 medical centres.Participants: Patients with steroid responsive recurrent-relapsing optic neuropathy.Methods: Semiprospective case series of IVIg treatment in steroid-responsive recurrent-relapsing optic neuropathy at 4 medical centres. Outcome measures included visual outcome; time to, and duration of, remission; duration of corticosteroid use; and adverse events.Results: Vision stabilized in all 6 patients treated with IVIg without steroids for extended periods of time. None improved and none worsened. One adverse event occurred during an IVIg infusion after 3 uneventful years of IVIg maintenance. Average steroid use prior to IVIg was 12 months. After IVIg treatment, 5/6 patients no longer required corticosteroids. Two patients experienced late relapses on IVIg, one of whom was treated with cyclosporine, the other with steroids.Conclusions: IVIg can be considered an effective steroid-sparing agent in selected cases with steroid-dependent recurrent-relapsing autoimmune optic neuropathy.     

儿童视神经炎临床特点及预后分析

目的 探讨儿童视神经炎的发病特点,为视神经炎患儿的诊疗及护理提供依据。设计 回顾性病例系列。研究对象2010年1月1日至2012年12月31日就诊于解放军总医院的75例（124眼）儿童视神经炎患者。方法 回顾性分析75例（124眼）儿童视神经炎患者的病例资料,记录其发病诱因、发病特点、临床表现,分析其临床特点。跟踪随访6~42个月,进一步分析其预后及转归。主要指标 发病诱因、临床表现、复发率及预后。结果 入组患者平均年龄（10.67±3.57）岁,其中女性56例（74.67%）,29例（38.67%）患者发病前有明确诱因。所有患者发病以来均有不同程度的视力下降,49例（65.33%）患者双眼同时或先后发病。32例（42.67%）患者发病时伴有眼痛或眼球转动痛。所有患者发病眼视盘均有不同程度颜色变淡并与发病时间有关,约51.52%的患者病情复发,但近70%的患者视力恢复>0.5。分别有4例（6.78%）及9例（15.25%）患者转变为多发性硬化及视神经脊髓炎。结论 儿童视神经炎以严重的视力下降、双眼发病为主及良好的预后为特点;年龄偏大的女性患者较易转变为视神经脊髓炎。     

Fractal analysis of fluoroangiographic patterns in anterior ischaemic optic neuropathy and optic neuritis: a pilot study

Background:  To evaluate by means of fractal analysis the vascular pattern of the optic nerve head obtained by fluorescein angiogram, in non-arteritic anterior ischaemic optic neuropathy (NAION) and optic neuritis (ON).
Methods:  Twenty-nine patients at the Department of Ophthalmology of the University of Siena, diagnosed as having either NAION or ON by clinical and instrumental criteria, were prospectively subjected to fractal analysis: 11 patients with NAION and 18 patients with ON. In the ON group, 12 patients showed optic disc oedema, whereas six patients showed no optic disc oedema. The unaffected eyes of six patients with NAION and of seven patients with ON associated with optic disc oedema served as controls.
Results:  The mean fractal dimension D was 1.84 ± 0.09 in the NAION group, 1.92 ± 0.04 in the ON group with optic disc oedema, 1.86 ± 0.04 in the ON group without optic disc oedema and 1.63 ± 0.06 in the control group; all case groups showed significantly higher values than controls ( P  < 0.01). Among the case groups, the ON group with optic disc oedema showed a significantly higher mean fractal dimension value than the others ( P  < 0.01).
Conclusions:  Our data suggest that eyes with ON and NAION seem to have increased vascular complexity in the optic nerve head, manifested as an increase in fractal dimension.