摘要
目的: 探讨非动脉炎性前部缺血性视神经病变(nonarteritic anterior ischem icoptic neuropathy,NAION)的临床特点、治疗效果、视力预后以及影响因素。方法: 采用回顾性病例分析方法,收集2006-01/2009-12在我院诊治的NAION患者116例116眼临床资料,分析其发病特点、眼底表现和荧光素眼底血管造影改变、治疗前后视力变化以及相关危险因素,治疗方法包括控制全身疾病、全身应用扩张血管药物、神经营养药物或糖皮质激素治疗。结果: 所有患者中,男65例,女51例;平均发病年龄为56.4±9.8岁。所有患者眼底均表现为视乳头水肿和边界不清,部分患者伴有视乳头旁出血。视野检查多表现为水平视野缺损,以下方或鼻下方视野缺损常见(53.7%)。荧光素眼底血管造影早期表现为视乳头部分血管荧光素充盈延缓,晚期表现为视乳头弥漫性强荧光和荧光素渗漏。经系统治疗后所有患者视乳头水肿消失,遗留有视乳头颜色变淡。116例116眼患者的初诊平均最佳矫正视力为0.52±0.21,治疗后末次随访最佳矫正视力为0.68±0.20,治疗后平均视力有显著提高(t=10.61,P=0.000)。治疗后多数患者的视野缺损有明显好转或稳定,视野缺损扩大者17眼(14.7%)。116例患者中伴发心脑血管疾病者72例(62.1%),其中高血压病52例(44.8%),糖尿病27例(23.3%)。经Logistic回归分析发现,患者最终视力低下(0.5及以下)与初诊时视力低下(0.5及以下)、糖尿病病史和老龄(60岁以上)密切相关,未发现与性别、高血压病史等因素有关。结论: 中老年人高血压病或糖尿病是NAION的常见发病危险因素,正确诊断和及时治疗可有效改善视乳头缺血状态,提高患者视力和改善视野缺损状态。
·AIM： To investigate the clinical profiles, visual outcomes and related factors for the patients with nonarteritic anterior ischemic optic neuropathy （NAION）. · METHODS： From January 2006 to December 2009 in our hospital, 116 consecutive patients （116 eyes） with NAION were retrospectively analyzed. The clinical and fundus fluoresecein angiographic profiles, visual outcomes and related factors of the patients were recorded. The routine managements included controlling systemic diseases, systemic vasodilators, neuroprotection agents or oral corticosteroids.·RESULTS： Of 116 cases, 65 were males and 51 were females. The average ages were 56.4± 9.8 years. The unilateral onset were 98 cases （84.5%） and the bilateral onset were 18 cases （15. 5%）. The papillary edemas were seen in all patients and the peripapillary hemorrhages were seen in some patients. The visual field defects were seen in all patients, and the inferior altitudinal defects or nasal inferior defects were common （53. 7%）. The filling defect or delay was seen in allpatients at the early stage of fluorescein fundus angiography and the optic disc staining or diffuse fluorescein leakage at the late stage. After the active treatment for 2-3 months, the papillary edemas were subsided, and the optic nerve were sectoral or diffuse atrophy. The visual fields defects of 87.3% eyes were improved or stable, and 12.7% eyes were residual partial visual defect. The average best-corrected vision of 116 eyes at the initial visit were 0.52±0.21, and the corrected vision at the final visit were 0.68±0.20, the vision were improved after the treatment （ t = 10. 61, P = 0. 000）. Among the 116 patients, 72 cases （62. 1%） were with cardiovascular disorders, 52 cases （44. 8%） with systemic hypertension and 27 cases （23. 3%） with diabetes mellitus. After the logistic regression analysis, the related factors for the lower final visual acuity （0.5 or less） were related to the lower initial vision（0.5 or less）, diabetes mellitu
出处
《国际眼科杂志》
CAS
2013年第8期1657-1659,共3页
International Eye Science
关键词
视神经疾病
缺血性
诊断
治疗
预后
optic neuropathy/ischemic
diagnosis
treatment
prognosis
