中医辩证治疗间接性视神经损伤

头颅、面部损伤 ,特别是眼眶周围损伤 ,常造成视神经损伤 ,致视力锐减。而检眼镜检查无眼球及视神经改变 ,称之为间接性视神经损伤[1] 。它严重影响患者视力 ,给工作、生活造成极大不便及精神痛苦 ,临床治疗比较困难。根据外伤性视神经的发生机制 ,特别是眶部受冲击时的视神经管内视神经的病理学特性[2 ] 等 ,外伤后应早期积极应用药物治疗 ,减少视神经内实质水肿、炎症反应、加强营养并修复受损伤的视神经。对治疗视神经损伤及间接性伤都是有很重要的意义。有关外伤性视神经损伤的治疗有很多方法 ,特别是中药疗法取得了可喜的效果。探讨一…     

颅外伤合并间接性视神经损伤

目的 探讨颅外伤合并间接性视神经损伤的临床诊断和治疗。方法 回顾分析了颅外伤合并间接性视神经损伤36例（36眼）的临床资料。11例行视神经减压术，25例接受药物治疗。结果 全部患者伤侧眼的相对瞳孔传入障碍（RAPD）阳性；眼眶CT扫描显示有眶壁和／或鼻窦骨折。药物治疗组有8例（32．00％）视力提高1行，其余17例（68．00％）视力无改善，手术治疗组有1例（909％）由数指／1．5m提高到03，5例（45．46％）恢复了瞳孔直接对光反应，1例（9．09％）恢复了VEP波，其余4例（36．36％）视力无改善。结论 对颅外伤患者应进行RAPD检查及眼眶CT扫描，确定有无间接性视神经损伤。皮质类固醇和视神经减压联合应用可能更有利于视功能的恢复。     

经颅视神经管减压治疗视神经损伤

视神经管骨折后可致视神经间接损伤 ,如能早期诊断和治疗 ,可挽救病人的视力。 1997年 8月～ 2 0 0 0年 10月我们对 10例视神经管骨折伴视神经损伤的患者进行了视神经管减压开放术 ,现报告如下。1　资料与方法1.1　一般资料　本组病例共 10例 ,其中男 8例 ,女 2例 ,年龄 12～ 5 0岁 ,平均 36岁。受伤原因 :车祸伤 4例 ,坠落伤 3例 ,砸伤 2例 ,锐器伤 1例。受伤部位 :右额颞部 5例 ,左颞部2例 ,右额部 2例 ,左额颞部 1例。受伤后来院时间 :2 h～ 2 d。手术时间 :伤后 2 4h内 4例 ,3d内 4例 ,5 d内 2例。临床表现 :伤后轻度昏迷 3例 ,均在伤后…     

急性颅脑损伤合并视神经损伤的护理观察

目的探讨急性颅脑损伤合并视神经损伤的护理，如何减少漏诊，提高早期诊断率。方法对1026例急性颅脑损伤重点观察瞳孔大小和对光反应，清醒病人加查视力和视野。结果1026例急性颅脑损伤者中发现合并视神经损伤者24例。结论护士及时准确掌握第一手临床资料，对早期诊断视神经损伤至关重要。     

外伤性视神经损伤

外伤性视神经损伤徐丽蒋慧蓉夏德昭中国医科大学附属第一医院眼科（１１０００１）外伤性视神经病变（ＴｒａｕｍａｔｉｃＯｐｔｉｃＮｅｕｒｏｐａｔｈｙ，ＴＯＮ）是指在外部强大的冲击力作用下，引起视神经功能部分或全部的丧失，损伤可以是永久性或是暂时的，可以在视...     

视神经间接损伤

本从视神经解剖学，视神经损伤的分类，临床病理资料，病理生理机制，临床检查技术，神经放射学方法及临床治疗方面、分别讨论了视神经间接损伤。     

视神经损伤的基因治疗

视神经损伤因缺乏有效治疗手段,预后不良,有关其治疗方法的研究成为眼科学界的热点之一.目前研究认为原发性损伤后,继发的视网膜神经节细胞(RGCs)凋亡是造成视神经损伤的重要机制,及时有效地减少RGCs凋亡对视神经的保护具有重要作用.随着分子生物学技术的发展,视神经损伤的基因治疗备受关注,并有望从实验室走向临床,成为有效治疗手段.本文就视神经损伤基因治疗的现状及前景做一综述.     

管内段视神经间接损伤

管内段视神经间接损伤,系指视神经管骨折所致或管内段视神经受挫伤所致视神经损伤。本病视力损失严重,甚至无光感。只有早期诊断及时治疗,部份患者尚可不同程度恢复视力。我院近1年半遇15例,现报告如下:     

CONTUSION INJURIES OF THE OPTIC NERVE

Indirect trauma to the optic nerve with secondary optic atrophy may result from minor trauma and has traditionally been associated with a poor visual prognosis. The case of a 32-year-old man who suffered a blow to his left supraorbital region and eyebrow in an automatic closing door is reported to draw attention to the uncommon but trivial nature of this injury which may result in profound visual loss. He suffered an initial inferonasal visual field loss which was related to vascular changes in the optic nerve head. Over the ensuing year there was deterioration in his central vision and visual field due to arachnoiditis.
Current trends in the management of optic nerve contusion injuries are discussed. There is currently a move towards primary medical management with high-dose corticosteroids as in this case; surgery is reserved for those patients who fail to respond to steroids or deteriorate as the steroid dose is reduced.     

THE DEVELOPMENT OF THE OPTIC NERVE IN RODENTS

In mammals, normal visual function depends upon both the retinotopic organization of visual nuclei and their interconnections. We have investigated in rodents some developmental mechanisms contributing to this organization.
On embryonic day 14, in the rat, retinal ganglion cells first project axons through glial channels on the retinal surface before reaching the optic stalk. We suggest that the sequence in which axons enter the stalk (central before peripheral) and their prominent fasciculation impose some retinotopic order amongst the emerging optic nerve fibres.
At birth (embryonic day 21) there are over 240 000 axons in the optic nerve, all non-myelinated. However, within one week, the number falls to the adult value (100 000) and myelination, complete in the adult, commences. Axons lost include some which misproject–to the opposite eye or to inappropriate parts of central visual regions. The number of surviving retinal ganglion cells depends on the amount of appropriate target tissue available.
It is well established that removal of one eye early in development increases the survival of axons in the remaining optic nerve. However, in a group of adult mice with congenital unilateral anophthalmia, we counted only 21 000 optic axons in the remaining nerve compared with the 31 000 in normal mice of the same strain. Degenerating axons were observed, suggesting that the defect is not a simple developmental failure, but is associated with active degenerative processes throughout life.     

VITRECTOMY AND PHOTOCOAGULATION IN THE MANAGEMENT OF SEROUS DETACHMENT ASSOCIATED WITH OPTIC NERVE PITS

Two cases of serous detachment of the retina associated with congenital pits of the optic nerve were successfully treated with photocoagulation, vitrectomy and gas tamponade. The rationale of management and the results are discussed. It is suggested that this treatment deserves further study to see if early intervention will favourably affect the return of macular function, particularly in cases of optic nerve pits where the serous detachment is of short duration and fixed structural changes at the macula have not occurred.     

前部缺血性视神经病变视网膜神经纤维层损害的初步观察

用无赤光眼底照相法结合眼底荧光血管造影及定理视野分析，对２３例（２５眼）前部缺血性视神经病变患者的视网膜神经纤维层进行观察。有２３眼（９２％）检出ＲＮＦＬ缺损并伴有相应的视野缺损。视盘荧光充盈缺损与ＰＮＦＬ缺损及视野缺损三者之间有高度的对应关系，表明ＡＩＯＮ可造成ＲＮＦＬ缺损，并导致相应的视功能损害。     

OPTIC NERVE HYPOPLASIA: CHANGING PERSPECTIVES

Optic nerve hypoplasia, having once been regarded as exceedingly rare, is now regarded as one of the major causes of visual loss in infancy. Recognition of subtle forms and segmental forms of optic nerve hypoplasia are important in explaining the evaluation of subnormal vision. and have an added significance in the recognised associations of central nervous system anomalies including abnormalities of the endocrine system. These changing clinical perspectives are reviewed, together with a discussion of the pathogenesis of optic nerve hypoplasia in the light of cell death and nerve fibre degeneration seen in normal development of the neural visual system.     

视神经病变的稳态闪光视觉诱发电位

我们对46例正常人（89眼）和35例（51眼）视神经病变病人记录其稳态闪光视诱发电位，其中58.8%的患眼视力＜1.记录的波形通过离散傅里叶转换，提取基波和二次谐波的振幅和相位作为波形的特征值。结果表明，患眼总的异常率为80.4%。异常改变可呈现4种类型：振幅降低，相位异常，振幅降低和相位异常，平坦波形。就稳态闪光视诱发电位对视神经病变诊断的意义及临床应用的优点进行了讨论。 （中华眼底病杂志，1994，10：213-215）