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.     

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。     

鼠神经生长因子联合复方樟柳碱治疗非动脉炎性前部缺血性视神经病变

目的：评价鼠神经生长因子联合复方樟柳碱对非动脉炎性前部缺血性视神经病变(nonarteritic anterior ischemic optic neuropathy, NAION)的疗效。

方法：采用临床病例系列研究,将122例单眼发病NAION患者分为3组,所有患者均接受常规治疗。对照组A(40例40眼)给予复方樟柳碱注射液2mL/次颞浅动脉旁皮下注射,2次/d; 对照组B(41例41眼)鼠神经生长因子30μg/次肌肉注射,1次/d; 联合组(41例41眼)同时给予复方樟柳碱和鼠神经生长因子治疗,连续治疗4wk。每天观察视力、眼底,治疗结束后检查记录最佳矫正视力(BCVA)、视野、OCT,对结果进行统计分析。

结果：联合组视力、视野恢复优于两对照组,差异有统计学意义(P<0.05),视神经纤维层变薄联合组少于两对照组,差异有统计学意义(P<0.05); 两对照组视力、视野、视神经纤维层变化均无统计学差异(P>0.05)。对照组A治疗有效率为70%,对照组B有效率为65.9%,联合组有效率为92.7%,联合组有效率显著高于两对照组,差异有统计学意义(P<0.05); 两对照组间总体治疗效果无统计学差异(P>0.05)。

结论：鼠神经生长因子联合复发樟柳碱可显著提高NAION治疗效果。     

曲安奈德联合鼠神经生长因子治疗合并糖尿病的非动脉炎性前部缺血性视神经病变

目的为合并糖尿病的非动脉炎性前部缺血性视神经病变(NAION)患者探寻更安全、有效的治疗方案。方法收集我院2年来确诊的合并糖尿病的NAION患者40例(40只眼),随机分为2组,各20例,对照组给予局部、全身激素冲击,降眼压,改善微循环营养支持的传统治疗方案。实验组给予曲安奈德注射液40 mg球后注射1次联合肌肉注射鼠神经生长因子18μg,2周为主的治疗。记录治疗前及治疗后1个月复诊时的视力、中心视野情况并作统计学分析。结果最佳矫正视力、视野平均敏感度、平均缺损:治疗前实验组依次为0.21±0.16、17.45±6.90、9.32±6.80,对照组为0.23±0.18、17.12±4.64、9.22±7.10;治疗后实验组为依次为0.49±0.12、22.96±5.12、5.03±6.02,对照组为0.38±0.10、20.47±5.01、6.03±6.98。实验组治疗效果及临床有效率优于对照组且数据差异有统计学意义(tv=3.15,ts=2.33,td=2.12,χ2=4.29,P<0.05)。结论实验组治疗方法更简便安全有效。建议选择适合病例临床使用。     

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患者的明适应负向波变化特点分析

目的　探讨非动脉炎性前部缺血性视神经病变（non-arterial anterior ischemic optic neuropathy,NAION）患者随病程变化的明适应负向波（photopic negative response,PhNR）变化特点。方法　选取2018年6月至12月就诊于我院的NAION患者18例作为NAION组,另选取正常16人作为正常对照组。根据NAION患者不同视盘水肿状态盘周视网膜神经纤维层（retinal nerve fiber layer,RNFL）厚度的差别,将NAION组进一步分为视盘水肿时的盘周RNFL厚度增加组（以下简称“增加组”）和视盘水肿消退后的盘周RNFL厚度正常及减少组（以下简称“正常及减少组”）。所有受检者均进行PhNR和光学相干断层扫描（optical coherence tomography,OCT）的盘周RNFL厚度检查。结果　NAION组与正常对照组相比,PhNR幅值［分别为（28.23±14.62）μV、（46.24±16.04）μV］显著降低,差异有统计学意义（P=0.00）。增加组、正常及减少组与正常对照组相比,PhNR幅值［（28.77±11.87）μV、（27.96±16.32）μV、（46.24±16.04）μV］均显著降低,差异均有统计学意义（P=0.03、0.00）,但增加组和正常及减少组相比,PhNR幅值差异无统计学意义（P=0.92）。增加组PhNR幅值与RNFL厚度呈负相关性（r=-0.86,P=0.03）,正常及减少组PhNR幅值与RNFL厚度呈正相关性（r=0.96,P=0.00）。结论　NAION患者发病初期PhNR幅值即显著降低,随着病程进展,PhNR幅值未发生显著变化。NAION视盘水肿时盘周RNFL厚度越大,PhNR幅值越低;视盘水肿消退后盘周RNFL厚度越小,PhNR幅值越低。     

非动脉炎性前部缺血性视神经病变危险因素的研究现状

非动脉炎性前部缺血性视神经病变(nonarteritic anterior ischemic optic neuropathy,NAION)是中老年人群中最常见的急性视神经病变。尽管其病因学和发病机制尚不十分清楚,近年来对其危险因素的研究取得一些进展。本文从小视乳头、心血管危险因素、失血、睡眠呼吸暂停综合征、药物、白内...     

综合疗法治疗非动脉炎性前部缺血性视神经病变

目的观察复方樟柳碱联合高压氧综合治疗非动脉炎性前部缺血性视神经病变(NAION)的疗效。方法采用随机方法将患者58例(64只眼)分入观察组30例和对照组28例。对照组采用局部注射激素,全身应用低分子右旋糖酐、复方丹参液、神经营养剂。观察组:除应用同对照组相同的药物外,予复方樟柳碱作患侧颞浅动脉旁皮下注射,配合高压氧综合治疗。以视力、视野、眼底改变为疗效判断指标。结果有效率治疗组为83.33%,对照组为53.57%,二者比较,差异有显著性意义(P<0.05)。结论复方樟柳碱联合高压氧综合疗法可提高非动脉炎性前部缺血性视神经病变的疗效。     

Effects of Nerve Growth Factor in the Treatment of Non-Arteritic Anterior Ischemic Optic Neuropathy

Objective: To observe the effects of nerve growth factor (NGF) in the treatment of non-arteritic anterior ischemic optic neuropathy (NA-AION). Methods: This was a prospective, randomized, controlled study. Fifty-eight NA-AION patients (58 eyes) admitted to Lianshui County People's Hospital from July 2016 to June 2019 were selected, and then were divided into a control group and an observation group based on the random numerical table method. The control group (29 patients with 29 eyes) were given glucocorticoid hormones, Huoxue Tongluo granules and an anisodine compound. While the observation group (29 patients with 29 eyes), were treated with NGF in addition to the treatment plan previously described. The total effective rate, best corrected visual acuity (BCVA), the 30-degree visual-field examination mean deviation (MD) and the disc retinal nerve fiber layer (RNFL) thickness of the two groups were compared. Data were analyzed by the Fisher's exact test, a t test and a non-parametric test. Results: After treatment, the total effective rate for the observation group was significantly higher than that for the control group (P=0.04),the percentage of BCVA above 0.1 in the observation group was significantly higher than that in the control group (P<0.001), and both the MD and RNFL thickness in the observation group were significantly lower than those in the control group (t=2.59, P=0.01; t=4.86, P<0.001). There were no obvious adverse reactions for either group after treatment. Conclusions: The treatment of NA-AION with NGF can obtain a better effective rate, improve the patient's vision, improve the visual field and reduce RNFL thickness.     

Adalimumab and Non-Arteritic Anterior Ischaemic Optic Neuropathy: A Case Report

Abstract

Sequential anterior ischaemic optic neuropathy was observed in a patient treated with a tumour necrosis factor α (TNF) inhibitor, adalimumab, for ankylosing spondylitis. He developed decreased visual acuity in the right eye after 17 months of treatment. Findings showed right optic disc oedema with haemorrhages and visual field defect. Adalimumab was discontinued and vision stabilised. After restarting adalimumab, he developed optic neuropathy in the left eye. Findings showed optic disc oedema, with haemorrhages and visual field changes in the left eye. Adalimumab may be associated with optic neuropathy; providers prescribing TNF inhibitors should be aware of optic neuropathy as a potential complication.     

Treatment of Nonarteritic Anterior Ischemic Optic Neuropathy

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common clinical presentation of acute ischemic damage to the optic nerve. Most treatments proposed for NAION are empirical and include a wide range of agents presumed to act on thrombosis, on the blood vessels, or on the disk edema itself. Others are presumed to have a neuroprotective effect. Although there have been multiple therapies attempted, most have not been adequately studied, and animal models of NAION have only recently emerged. The Ischemic Optic Neuropathy Decompression Trial, the only class I large multicenter prospective treatment trial for nonarteritic anterior ischemic optic neuropathy, found no benefit from surgical intervention. One recent large, nonrandomized controlled study suggested that oral steroids might be helpful for acute NAION. Others recently proposed interventions are intravitreal injections of steroids or anti-vascular endothelial growth factor (anti-VEGF) agents. There are no class I studies showing benefit from either medical or surgical treatments. Most of the literature on the treatment of NAION consists of retrospective or prospective case series and anecdotal case reports. Similarly, therapies aimed at secondary prevention of fellow eye involvement in NAION remain of unproven benefit.     

Adalimumab and Non-Arteritic Anterior Ischaemic Optic Neuropathy: A Case Report

Sequential anterior ischaemic optic neuropathy was observed in a patient treated with a tumour necrosis factor α (TNF) inhibitor, adalimumab, for ankylosing spondylitis. He developed decreased visual acuity in the right eye after 17 months of treatment. Findings showed right optic disc oedema with haemorrhages and visual field defect. Adalimumab was discontinued and vision stabilised. After restarting adalimumab, he developed optic neuropathy in the left eye. Findings showed optic disc oedema, with haemorrhages and visual field changes in the left eye. Adalimumab may be associated with optic neuropathy; providers prescribing TNF inhibitors should be aware of optic neuropathy as a potential complication.     

Optical Coherence Tomography Angiography in a Patient with Optic Atrophy After Non-arteritic Anterior Ischaemic Optic Neuropathy

A 75-year-old female noticed a lower visual field (VF) defect in the right eye. A diagnosis of non-arteritic anterior ischaemic optic neuropathy (NAION) was made. The lower VF defect in the right eye did not change after onset. Optical coherence tomography (OCT) angiograms on the disc and the macula showed decreased retinal perfusion in the upper retina of the right eye. Retinal nerve fibre layer loss and ganglion cell complex loss in the upper retina were also seen in the right eye. OCT angiography could non-invasively detect the decrease of the retinal perfusion due to NAION.     

Risk Factors for Non-arteritic Anterior Ischaemic Optic Neuropathy in a Korean Population

To determine the risk factors for non-arteritic anterior ischaemic optic neuropathy (NAION) in Korean patients, medical records from 45 Korean patients group and 45 healthy controls group were retrospectively reviewed. 10 NAION risk factors, including age, sex, associated systemic disease, past medical/social history, and fundus findings were analyzed. Significant risk factors for NAION in Korean patients were diabetes mellitus (odds ratio (OR) = 3.613, p = 0.020), hypercholesterolaemia (OR = 5.200, p = 0.001), smoking (OR = 3.58, p = 0.014), microaneurysm/haemorrhage (OR = 5.375, p = 0.024), and crowded small cup (OR = 17.200, p < 0.001).     

Acute Unilateral Anterior Ischemic Optic Neuropathy Secondary to Optic Nerve Head Drusen: Report of a Rare Coexistence

A 45-year-old white male noticed on awakening the painless loss of inferior vision in the left eye 2 days ago. He was otherwise well and his medical history was unremarkable. Visual acuity was 20/20 in OD and 20/32 in OS with a left inferior altitudinal defect and right blind spot enlargement demonstrable on visual field test. On fundus examination, both disc margins were blurred and the left disc was diffusely oedematous, with linear haemorrhages in the adjacent nerve fibre layer. Radiologic imaging and laboratory tests were unremarkable. Bilateral optic nerve head drusen (ONHD) was demonstrated by optical coherence tomography and fundus autofluorescence imaging. Unilateral acute non-arteritic anterior ischemic optic neuropathy (NAION) and concomitant bilateral ONHD were diagnosed. NAION may develop secondary to ONHD. Therefore, clinicians should be aware of this rare association and inform the patients about this risk. Patients with ONHD should be followed-up periodically in terms of possible ischemic complications.     

Optic Disc Cupping in Arteritic Anterior Ischemic Optic Neuropathy Resembles Glaucomatous Cupping

Five cases of anterior ischemic optic neuropathy secondary to biopsy-proven giant cell arteritis are presented. In each case, cupping of the optic disc, which closely resembled glaucomatous cupping, was observed in the affected eye. The presence of glaucoma was ruled out on the basis of normal intraocular pressures and normal tonographic measurements of facility of outflow. These cases indicate that arteritic ischemic optic neuropathy can result in optic disc cupping, which closely resembles glaucomatous cupping. The similarities in the appearance of cupping of these discs with that seen in eyes with glaucoma suggest that the pathogenesis of cupping in glaucoma and in arteritic ischemic optic neuropathy may share some common mechanisms.     

角膜电刺激对糖尿病大鼠前部缺血性视神经病变模型的影响

观察并评估角膜电刺激对糖尿病大鼠前部缺血性视神经病变（AION）模型的影响。方法：实验 研究。健康雄性Sparague-Dawley大鼠40只，随机分组后抽出8只作为正常大鼠组。余下32只先予 以链脲佐菌素腹腔注射建立糖尿病大鼠模型，将造模成功的大鼠随机抽出8只作为糖尿病组，余下 24只糖尿病大鼠采用孟加拉玫瑰红联合532 nm激光方法建立AION大鼠模型。将24只造模成功的 AION大鼠随机分成3组，每组8只，分别为AION模型组，不予任何处理；电刺激组，予以角膜电刺 激（刺激参数为：电流1 mA，频率20 Hz，波宽1 ms/phase，刺激时间1 h，隔日1次，刺激2周）；假电 刺激组，电极安放位置与电刺激组相同，仅不接通电源。2周后5组大鼠进行眼底照相、光学相干断 层扫描和视觉诱发电位，然后处死，行视网膜及视神经冰冻切片，苏木精伊红染色观察。数据采用 单因素方差分析和LSD-t检验进行分析。结果：正常大鼠组视盘上半部视网膜厚度为（211±13）μm， 糖尿病大鼠组为（206±16）μm，AION模型组为（240±54）μm，假电刺激组为（216±11）μm，电刺 激组为（198±4）μm，5组视盘上半部视网膜厚度差异有统计学意义（F=2.854，P=0.038）。其中AION 模型组视盘上半部视网膜厚度高于正常组、糖尿病组、电刺激组，差异均有统计学意义（P<0.05）； 正常组与糖尿病组差异无统计学意义，AION模型组与假电刺激组未见明显差异。视觉诱发电位示 AION模型组N1潜伏期较电刺激组延长，差异有统计学意义（t=4.1，P<0.001）；AION模型组P1潜伏 期较正常组、糖尿病组、假电刺激组、电刺激组延长，差异均有统计学意义（t=4.1、2.5、2.6、3.2， P<0.05）；电刺激组N1-P1波幅大于假电刺激组，差异有统计学意义（t=4.0，P<0.001）。结论：角膜电 刺激能促进糖尿病大鼠前部缺血性视神经病变模型肿胀的视盘变薄，加速视盘水肿的消退，同时在 一定程度上改善视功能。