非动脉炎性前部缺血性视神经病变患者急性期视盘周围脉络膜血流信号分析

目的　利用光学相干断层扫描血管成像（OCTA）观察非动脉炎性前部缺血性视神经病变（NAION）患者急性期的视盘周围脉络膜血流信号特征。方法　对2017年1月至2019年9月首次确诊为NAION且接受OCTA检查的13例（13眼）患者进行回顾性横断面研究。由两位医师分别定性分析OCTA中脉络膜毛细血管层的血流信号中的低信号区,并分区。将分区的结果与en face OCT、视野检查结果进行对比。患者均至少随访1个月。结果　急性期NAION患眼的视盘OCTA在脉络膜毛细血管层水平的低信号区可分为视盘本身部位、视盘水肿部位和沿神经纤维方向延伸部位3个区域。13眼中,10眼首次就诊时出现3个低信号区,2眼在第2次就诊时出现3个低信号区,1眼仅出现视盘本身部位和视盘水肿部位的低信号区。其中,沿神经纤维方向延伸部位的低信号区与视野缺损关系密切,对应比例达91.6%,该低信号区平均出现时间为发病后19.9 d。随访期内,9眼沿神经纤维方向延伸部位的低信号区出现神经纤维层萎缩。结论　NAION患者急性期的视盘周围脉络膜层面的血流信号可以通过OCTA提示神经纤维层水肿、消退以及萎缩的变化过程。     

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。     

非动脉炎性前部缺血性视神经病变视盘形态学定量研究

目的 研究非动脉炎性前部缺血性视神经病变(NAION)视盘形态结构特征,探讨 NAION 的发病机制.方法 应用海德堡视网膜断层扫描仪(HRT)对71例NAION患者对侧未发病眼及69名正常人随机选择一眼的视盘进行检测,对NAION患者和正常人的视盘参数进行比较分析.结果 NAION组视盘面积,视杯面积,杯盘面积比,平均视杯深度,最大视杯深度,视杯形态测量均小于正常对照组(P<0.05. NAION患者与正常组盘沿面积无差异(P>0.05. NAION组杯盘面积比小于等于0.2占91.5%,而对照组占40.6%,其中NAION组无视杯为14例,对照组仅为1例,NAION组无视杯的发生率明显高于对照组;两组杯盘面积比分布的差异具有统计学意义(P<0.05).结论 小视盘,小视杯及浅视杯是NAION患者视盘的形态学特点,也是导致NAION的解剖基础.     

非动脉炎性前部缺血性视神经病变的糖皮质激素治疗

非动脉炎性前部缺血性视神经病变尚无被国内外眼科同行广泛接受,经过严格科学验证的有效治疗方法以恢复患眼的视功能损害和防止对侧眼的累及,是否应该采用糖皮质激素类药物治疗以及哪种给药方式的疗效最佳、副反应最小是近几年来国外神经眼科学界争论的热点问题之一.此文对非动脉炎性前部缺血性视神经病变糖皮质激素治疗研究的现状做出综述分析,以期为其治疗研究提供参考.     

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。     

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。     

非动脉炎性前部缺血性视神经病变治疗进展

非动脉炎性前部缺血性视神经病变(nonarteritic anterior ischemic optic neuropathy,NAION)是全身血管危险因素及局部解剖因素等多因素共同参与的、发病机制复杂的视神经缺血性疾病.控制全身危险因素是治疗关键.目前三大治疗尝试包括改善循环(如眼压干预、体外反搏、手术),减轻视盘...     

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）     

非动脉炎性前部缺血性视神经病变的危险因素分析

目的观察非动脉炎性前部缺血性视神经病变(NAION)的危险因素,为该病提供防治措施。方法对我院2009年至2013年5年间住院的并确诊为NAION的患者和同期体健中心的体检人群的实验室检查、24 h血压、全身及一般情况、眼部检查等进行分析,籍以说明其患病的危险因素,深入研究各种因素与该病的相互关系及特点,并通过临床干预性治疗,显现出该研究对此类疾病预后的影响。结果病例组发病年龄(57.89±10.32)岁,男性占47.84%,女性占52.16%。病例组中高血压、高血糖、胆固醇、甘油三酯、红细胞压积偏低及颈动脉超声异常的比例分别是49.07%、33.02%、23.53%、29.9%、8.25%及59.73%。对照组年龄(54.02±11.85)岁,男性占57.58%,女性占42.42%,高血压、高血糖、胆固醇、甘油三酯、红细胞压积偏低及颈动脉超声异常比例分别是23.64%、10%、16.97%、27.87%、7.57%及41.05%。结论病例组高血压、高血糖、高血脂、红细胞压积偏低、颈动脉超声异常及夜间低血压发病率明显高于对照组。且病例组发病年龄有年轻化的趋势,男性略高于女性,高血压、高血糖、血脂、颈动脉异常及夜间低血压等是主要的危险因素。对于NAION的患者应积极查找全身病因,并给予有效干预。对高危人群和已患病人群做出高发病例、治疗预后等情况做出科学的评估。     

非动脉炎性前部缺血性视神经病变视盘形态变化及其对视觉功能的影响

目的应用形态测量学方法评估非动脉炎性前部缺血性视神经病变（NAION）患者杯／盘直径比（C／D）和视神经乳头旁α区和β区的变化,探讨视盘形态变化与NAION的关系。方法选取154例单眼或双眼发病NAION患者,采用德国CarlZeiss公司Humphrey2000型OCT检查系统连续拍摄视盘形态,对数据进行统计学分析和处理。结果随访时间为12个月。水平扫描和垂直扫描视盘直径分别为（P=0．30,P=0．61）,水平扫描和垂直扫描C／D比分别为（P=0．47,P=0．19）,乳头旁α区和β区分别为（P=0．27,P=0．32）。单眼NAION组患眼和对侧眼之间无明显差异。单侧NAION组和双侧NAION组未受影响眼之间,水平扫描和垂直扫描视盘直径、水平扫描和垂直扫描C／D比、与α区和β区比较无显著差异（P〉0．05）。NAION组患眼视力、视盘直径、C／D比、视盘旁α区或β区无显著相关性（P〉0．20）,单侧NAION组患眼和对侧眼视力之间无显著差异（全部P〉0．25）。结论NAION组不影响C／D比值,也不影响视盘旁α区和β区。视盘形态大小与NAAION组视力无相关性。     

Optical coherence tomography angiography of optic disc perfusion in non-arteritic anterior ischemic optic neuropathy

AIM: To compare the optic disc blood flow of non-arteritic ischemic optic neuropathy (NAION) eyes with normal eyes. METHODS: The optic disc blood flow densities of diagnosed non-acute phase NAION eyes (21 eyes, 14 individuals) and normal eyes (19 eyes, 12 individuals) were detected via Optovue optical coherence tomography angiography (OCTA). The optic disc blood flow was measured via Image J software. Correlations between optic disc perfusion and visual function variables were assessed by linear regression analysis. RESULTS: The average percentage of the optic disc non-perfusion areas in the non-acute phase NAION patients (17.84%±6.18%) was increased, when compared to the normal control eyes (8.61%±1.65%), and the difference was statistically significant (P<0.01). Moreover, there was a proportional correlation between the visual field mean defect (MD) and the optic disc non-perfusion area percentage, and the relationship was statistically significant (t=3.65, P<0.01, R2=0.4118). In addition, the critical correlation between the best corrected visual acuity (BCVA) and the optic disc non-perfusion area percentage was statistically significant (t=4.32, P<0.01, R2=0.4957). CONCLUSION: The optic disc non-perfusion area percentages detected via OCTA in NAION eyes were significantly increased when compared with the normal eyes. Both the BCVA and MD were correlated with the optic disc flow detected, revealing that OCTA may be valuable in the diagnosis and estimation of NAION.     

Analysis of optic disc damage by optical coherence tomography in terms of therapy in non-arteritic anterior ischemic optic neuropathy

This study aimed to assess the relationship between the rate of nerve fiber loss in non-arteritic anterior ischemic optic neuropathy (NAION) and time delay before therapy. Total 24 patients received the same treatment within or after 2wk (early and late groups). There were significantly lower level of destruction of nerve fibers (P=0.0014) and significantly better visual field sensitivity (P=0.039) in early group. The results indicate that therapy should be started within 2wk. The degree of ischemic damage due to NAION correlates well with retinal nerve fiber layer thickness and the ischemia-induced decrease in visual field sensitivity.     

[In Press] Optical coherence tomography angiography of optic disc perfusion in non-arteritic anterior ischemic optic neuropathy

AIM: To compare the optic disc blood flow of non-arteritic ischemic optic neuropathy (NAION) eyes with normal eyes.. METHODS: The optic disc blood flow densities of diagnosed non-acute phase NAION eyes (21 eyes, 14 individuals) and normal eyes (19 eyes, 12 individuals) were detected via Optovue optical coherence tomography angiography (OCTA). The optic disc blood flow was measured via Image J software. Correlations between optic disc perfusion and visual function variables were assessed by linear regression analysis. RESULTS: The average percentage of the optic disc non-perfusion areas in the non-acute phase NAION patients (17.84%±6.18%) was increased, when compared to the normal control eyes (8.61%±1.65%), and the difference was statistically significant (p < 0.01). Moreover, there was a proportional correlation between the visual field mean defect (MD) and the optic disc non-perfusion area percentage, and the relationship was statistically significant (t = 3.65, p < 0.01, R2 = 0.4118). In addition, the critical correlation between the best corrected visual acuity (BCVA) and the optic disc non-perfusion area percentage was statistically significant (t = 4.32, p < 0.01, R2 = 0.4957). CONCLUSION: The optic disc non-perfusion area percentages detected via OCTA in NAION eyes were significantly increased when compared with the normal eyes. Both the BCVA and MD were correlated with the optic disc flow detected, revealing that OCTA may be valuable in the diagnosis and estimation of NAION.     

非动脉炎性前部缺血性视神经病变与腹型肥胖的相关性研究

目的:探讨腹型肥胖与非动脉炎性前部缺血性视神经病变(non-arteritic anterior ischemic optic neuropathy,NAION)发生的相关性。方法:连续收集45例中国陕西籍或长期居住在北方地区的汉族NAION患者作为观察对象(即NAION组),并且无糖尿病、严重心脑血管疾病、肝肾功能不全等疾病;选择45例按年龄、性别、体质量指数条件与观察对象相匹配的健康查体者或其它眼病患者,自愿参与作为对照组。男性腰围≥85cm,女性腰围≥80cm,定义为腹型肥胖。结果:NAION组中腹型肥胖31例(69%)高于对照组21例(47%),两者比较有统计学差异(P<0.05);NAION组中吸烟者26例(58%),饮酒者20例(44%),对照组中吸烟者11例(24%),饮酒者16例(36%),吸烟方面两组间有统计学差异(P<0.05),而饮酒在两组间无统计学差异(P>0.05)。结论:中国北方汉族人群腹型肥胖与NAION发病有一定的关系。     

长春胺缓释胶囊治疗非动脉炎性前部缺血性视神经病变的疗效及安全性

目的:观察长春胺缓释胶囊治疗非动脉炎性前部缺血性视神经病变的临床疗效及安全性.方法:将2015-01/09来我院就诊的急性期发病的单眼非动脉炎性前部缺血性视神经病变(non-arteritic ischemic optic neuropathy,NAION)患者42例42眼,随机分为对照组(15例15眼)、治疗组(27例27眼),所有患者均给予大剂量激素(甲基强的松龙500~1000mg)、维生素B1、甲钴胺片营养神经治疗的同时,治疗组给予长春胺缓释胶囊口服治疗,30 mg/次,每天2次,疗程为3 mo.观察比较两组患眼治疗前后最佳矫正视力(best corrected visual acuity,BCVA)、平均视野缺损(mean deviation,MD)、平均盘周神经纤维层厚度(retinal nerve fiber layer,RNFL)、视网膜神经节细胞复合体厚度(ganglion cell complex,GCC)、图形视觉诱发电位(pattern visual evoked potential,PVEP)P100波潜伏期及振幅等变化.结果:治疗后,治疗组患眼视力治疗有效率较对照组高;治疗组与对照组患眼MD均较治疗前降低,差异有统计学意义(t=2.342、2.692,P=0.027、0.041).治疗后,治疗组与对照组PVEP振幅较治疗前均未见明显变化,差异无统计学意义(t=1.952、1.840,P=0.062、0.089);治疗组与对照组PVEP潜时值与治疗前比较无统计学差异(t=2.018、1.301,P=0.054、0.216);治疗组与对照组盘周神经纤维层厚度、神经节细胞复合体厚度都比治疗前变薄,差异均有统计学意义(P<0.001),对照组萎缩程度更严重.两组治疗均有效,治疗组效果优于对照组.尚未发现与长春胺缓释胶囊的口服治疗相关的不良事件发生.结论:长春胺缓释胶囊治疗NAION具有较好的临床疗效及安全性,能够起到辅助治疗、减少视神经损伤的作用.     

非动脉炎性前部缺血性视神经病变眼微视野固视性质分析

目的:分析非动脉炎性前部缺血性视神经病变(NAION)眼的微视野固视性质。方法:选择NAION患者23例27眼,分别以检眼镜法和Nidek MP-1微视野仪检测其固视性质,并对检测结果进行比较。结果:以检眼镜法检测,18眼表现为中心固视,9眼表现为中心外固视;以微视野法检测,18眼表现为稳定的中心固视,9眼表现为中心外固视,其中相对不稳定固视6眼,不稳定固视3眼。中心固视眼视力明显好于中心外固视眼(P<0.05)。结论:检眼镜法检测NAION患者的固视性质时可以明确区分中心固视和中心外固视,微视野法则可以进一步对固视的稳定性加以分析。     

Acute changes in ganglion cell layer thickness in ischemic optic neuropathy compared to optic neuritis using optical coherence tomography

AIM:To elucidate the changes of different ganglion cell layer(GCL)thinning patterns between the optic neuritis(ON)and non-arteritic anterior ischemic optic neuropathy(NAION).METHODS:A prospective,observational study was conducted to evaluate the timing of GCL changes between acute ON and NAION using optical coherence tomography.RESULTS:Thinning on optical coherence tomography in the NAION group occurs as early as 11 d after symptomatic onset of vision loss and follows an altitudinal pattern.The mean superior-inferior GCL thickness difference in the NAION cohort was clinically significant at 5.7μm in the NAION cohort compared to controls of 0.8μm(P=0.032),but not significant in the ON group compared to controls with both groups measuring 1.1μm.Global thinning was significant for the ON group compared to controls at 7.2μm(P=0.011)but not the NAION group compared to controls at 1.35μm.CONCLUSION:These findings suggest that future treatments for NAION should be given early,and possibly before 11 d in order to prevent GCL and irreversible vision loss.     

先天性视盘占位病变继发非动脉炎性前部缺血性视神经病变的临床特征分析

目的 探讨先天性视盘占位病变相关的非动脉炎性前部缺血性视神经病变（NAION）的临床特征。设计 回顾性病例系列。研究对象 2010年1月-2019年6月北京同仁医院先天性视盘占位病变继发NAION患者9例（11眼）。方法 回顾及分析患者的眼科及头颅神经影像学资料。所有患者均经半年以上随访。主要指标 性别、年龄、发病眼别、视盘病变特征及与视野改变关系、头颅神经影像学表现。结果 9例继发NAION的先天性视盘占位病变中4例视盘黑色素细胞瘤,3例视盘内玻璃膜疣,2例视盘区残存有髓纤维。年龄26~65岁（中位数39岁）。7例单眼发生NAION,2例视盘内玻璃膜疣患者双眼先后发生NAION。发生NAION时患眼矫正视力0.05~1.0。可行视野检查的4例患者表现为水平下半缺损及向心性缩小。最后随访时均无视功能进行性损伤和病情复发。结论 先天性视盘占位性病变可继发NAION而出现视功能损伤。（眼科, 2020, 29： 141-146）     

Optical coherence tomography evaluation of retinal nerve fiber layer thickness in non-arteritic anterior ischemic optic neuropathy and primary open angle glaucoma: a systematic review and Meta-analysis

AIM: To assess the differences in average and sectoral peripapillary retinal nerve fiber layer (pRNFL) thickness using spectral domain optical coherence tomography (SD-OCT) in patients with non-arteritic anterior ischemic neuropathy (NAION) compared with those with primary open angle glaucoma (POAG).METHODS: A comprehensive literature search of the PubMed, Cochrane Library, and Embase databases were performed prior to October, 2021. Studies that compared the pRNFL thickness in NAION eyes with that in POAG eyes with matched mean deviation of the visual fields were included. The weighted mean difference (WMD) with 95% confidence interval (CI) was used to pool continuous outcomes.RESULTS: Ten cross-sectional studies (11 datasets) comprising a total of 625 eyes (278 NAION eyes, 347 POAG eyes) were included in the qualitative and quantitative analyses. The pooled results demonstrated that the superior pRNFL was significantly thinner in NAION eyes than in POAG eyes (WMD=-6.40, 95%CI: -12.22 to -0.58, P=0.031), whereas the inferior pRNFL was significant thinner in POAG eyes than in NAION eyes (WMD=11.10, 95%CI: 7.06 to 15.14, P≤0.001). No difference was noted concerning the average, nasal, and temporal pRNFL thickness (average: WMD=1.45, 95%CI: -0.75 to 3.66, P=0.196; nasal: WMD= -2.12, 95%CI: -4.43 to 0.19, P=0.072; temporal: WMD= -1.24, 95%CI: -3.96 to 1.47, P=0.370).CONCLUSION: SD-OCT based evaluation of inferior and superior pRNFL thickness can be potentially utilized to differentiate NAION from POAG, and help to understand the different pathophysiological mechanisms between these two diseases. Further longitudinal studies and studies using eight-quadrant or clock-hour classification method are required to validate the obtained findings.