摘要
目的探究非动脉炎性前部缺血性视神经病变(NAION)视野损伤特征及其影响因素。方法回顾性分析该院2015年7月—2020年7月收治的102例(102眼)NAION患者临床资料,分析其临床表现、眼部及全身危险因素、光学相干断层扫描(OCT)、眼底荧光素血管造影(FFA)结果,治疗方法包括控制全身疾病、糖皮质激素、神经营养药物、扩张血管药物治疗。结果所有患者中,主要症状是突然发生的无痛性视物不清或视物遮挡92眼(90.20%),初诊时表现为视乳头缺血水肿者66眼(64.71%),首诊时检查平均最佳矫正视力为(0.52±0.24)(0.1~1.0),其中能清晰说出具体发病时间者96眼(94.12%)。眼底检查均表现为视乳头水肿、边界不清,矫正视力在1.0及以上者12眼(11.76%),视野检查多为水平状视野缺损,矫正视力在0.6及以上者51眼(50.00%),盘周可有条状出血,上方视野缺损27眼(26.47%),不规则象限缺损6眼(5.88%),下方或鼻下方视野缺损63眼(61.76%),管状视野6眼(5.88%),FFA检查晚期为缺血区视乳头弥漫性强荧光62眼(60.78%),早期正常荧光充盈延缓或低荧光40眼(39.22%)。OCT检查显示视乳头周围视网膜神经纤维层厚度较对侧眼增厚者91眼(89.22%),较对侧眼变薄者11眼(10.78%)。研究对象中单纯伴发高血压病者25例(24.51%),单纯伴发高脂血症者7例(6.86%),单纯伴发糖尿病者5例(4.90%),脑血管疾病25例(24.51%),合并高血压糖尿病者17例(16.67%),其中24例血压控制不良或未予治疗,11例血糖控制不良或未予治疗。眼底有不同程度动脉硬化者49例(48.04%)。有吸烟史者49例(48.04%),烟龄1~27年,平均(7.69±0.75)年,头颅CT或磁共振(MRI)检查发现22例颅内有缺血灶或梗死灶(21.57%),颈动脉彩色多普勒检查发现颈动脉狭窄及附壁斑块者33例(32.35%)。多因素Logistic回归分析发现,不同情况患者与初诊时视力低下(≤0.5)、糖尿病病史、老龄(>60岁)密切相关(P<0.05),未发现与性别、高�
Objective To explore the characteristics and influencing factors of visual field injury in non-arteritic anterior ischemic optic neuropathy(NAION).Methods A retrospective analysis of the clinical data of 102 NAION patients(102 eyes)admitted to the hospital from July 2015 to July 2020.Analyzed its clinical manifestations,eye and systemic risk factors,optical coherence tomography(OCT),and fundus fluorescein angiography(FFA)results.Treatment methods include the control of systemic diseases,glucocorticoids,neurotrophic drugs,and vasodilator drugs.Results In all patients,the main symptom was sudden and painless blurred vision or obscured vision in 92 eyes(90.20%).66 eyes(64.71%)presented with ischemic edema of the optic head at the first diagnosis.The average best corrected visual acuity at the first visit was(0.52±0.24)(0.1-1.0).Among them,96 eyes(94.12%)could clearly tell the specific time of onset.Fundus examination showed papilledema,unclear borders,and 12 eyes(11.76%)with corrected visual acuity of 1.0 and above.Visual field examinations were mostly horizontal visual field defects,with 51 eyes(50.00%)with corrected visual acuity of 0.6 and above.There may be strip hemorrhage around the disc,and 27 eyes(26.47%)of the upper visual field defect.Irregular quadrant defects were found in 6 eyes(5.88%),and the inferior or subnasal visual field was defective in 63 eyes(61.76%).6 eyes(5.88%)with tubular visual field,62 eyes(60.78%)with diffuse intense fluorescence of the optic papilla in the late stage of FFA examination.Early normal fluorescence filling delayed or low fluorescence 40 eyes(39.22%).OCT examination showed that the thickness of the retinal nerve fiber layer around the optic papilla was thicker than that of the contralateral eye in 91 eyes(89.22%),and 11 eyes(10.78%)were thinner than that of the contralateral eye.Among the study subjects,25 cases(24.51%)were accompanied by hypertension alone,and 7 cases(6.86%)were complicated by hyperlipidemia.There were 5 cases(4.90%)with simple diabetes,25 cases(24.51%)wit
作者
龚琴
GONG Qin(Department of Ophthalmology,Xiaogan Central Hospital,Xiaogan,Hubei Province,432000 China)
出处
《系统医学》
2022年第3期1-4,16,共5页
Systems Medicine
关键词
非动脉炎性前部
视野损伤
缺血性
视神经病变
影响因素
Non-arteritic anterior part
Visual field injury
Ischemic
Optic neuropathy
Influencing factors
