药物与视神经管减压治疗急性球后视神经炎疗效观察

目的探讨药物与视神经管减压手术治疗急性球后视神经炎疗效。方法回顾1988～2005年收治双眼急性球后视神经炎54例108眼，经药物治疗与视神经管减压手术治疗（以下简称减压治疗）并观察其疗效。结果54例108眼经药物治疗16～20d有46例（85．19％）95眼（87．96％）视力恢复到0．5—1．2，但仍有8例（14．81％）13眼（12．04％）视力无光感～2m数指。选择视力最差的无光感～30cm数指的8例8眼施行减压治疗，术后药物继续治疗16～20d，术后8眼视力恢复到0．3～0．7。经3年观察，术侧眼视力0．5～1．0，眼底视乳头色正常；而未手术侧的5眼视力光感-20cm数指，眼底视乳头苍白，血管细小，呈鲜明对比，疗效迥然不同。结论①球后视神经炎经药物治疗，大多数病例视力恢复较好。②经药物治疗2—3周少数病例视力仍无光感一眼前指数，视乳头淡白，经CT或MRI检查排除颅内病变，而球后视神经明显增粗的重症病例，应行减压治疗，可恢复较好视力。

The effectiveness of drug treatment and optic canal decompression surgery in the treatment of acute retrobulbar optic neuritis

Objective To analyze the effectiveness of drug treatment and optic nerve decompression surgery for the treatment of acute retrobulbar optic neuritis. Methods One hundred and eight eyes in 54 acute retrobulbar optic neuritis cases treated between 1988 and 2005 were retrospectively analyzed to investigate the effectiveness of drug treatment and optic nerve decompression surgery. Results Among 108 eyes of 54 cases received medicine treatment for 16 - 20 d, the visual acuity of 95 （87.96%） eyes of 46 cases （85.19%） returned to 0.5 - 1.2, while the visual acuity of 13 （ 12.04% ） eyes of 8 cases （ 14.81% ） remained no light perception vision to 2m counting figures. The 8 cases received optic nerve decompression surgery and post - operational drug treatment for 16 - 20 d. The visual acuity of the 8 eyes recovered to 0.3 - 0.7. After 3 years observation, The visual acuity of the operative eyes remained 0.5- 1.0 and the color of discus opticus is normal. However, for the 5 eyes without surgery, the visual acuity stayed at light perception vision to 20cm counting figures, the discus opticus was pale and the blood vessels were small. Conclusion ①The majority of retrobulbar optic neuritis cases may recover good vision after drug treatment. ②Optic nerve decompression surgery should be performed in severe cases who remains no light perception vision and pale discus opticus after 2 to 3 weeks drug therapy as well as in pa- tients with enlarged retrobulbar optic nerve but without intracranial lesions. The vision can be improved after surgery.