多发性硬化患者视神经炎发作早期的相干光断层扫描表现

Analysis of optical coherence tomography in early stage of optic neuritis in multiple sclerosis patients

目的探讨多发性硬化（MS）患者在视神经炎发作早期的视网膜神经纤维层（RNFL）、黄斑区节细胞复合体层（GCC）及视神经乳头的改变。方法前瞻性系列病例研究。2007年2月至2010年11月中国医学科学院北京协和医学院北京协和医院眼科疑似视神经炎急性发作的MS患者22例，在其急性视神经炎发作1周内，应用相干光断层扫描技术（OCT）对其进行检查，测量RNFL平均厚度、GCC平均厚度，对RNFL地形图和视神经乳头三维重建进行分析。结果MS患者视神经炎发作1周内，首次发作的视神经炎早期眼的RNFL平均厚度为（141．55±53．73）μm，其中有75％（12／16）的受检眼RNFL平均厚度增加，GCC平均厚度范围为91．54～118．45μm，其中64％（7／11）的受检眼GCC平均厚度增加；复发的视神经炎早期眼的RNFL平均厚度为（59．71±8．98）I．Lm，其中有91．7％（11／12）的RNFL平均厚度变薄，GCC平均厚度范围为58．92～91．76μm，其中62．5％（5／8）的受检眼GCC平均厚度较正常薄；视神经炎发作早期眼的对侧眼的RNFL平均厚度为（125．45±26．16）μm，其中60％（6／10）的受检眼RNFL平均厚度增加，GCC平均厚度范围为90．35～117．37μm，43％（3／7）的受检眼GCC平均厚度增加；OCT较直接眼底镜检查可以更多发现视神经乳头水肿和RNFL增厚。结论MS患者在视神经炎首次发作早期、复发早期具有不同程度的RNFL、GCC及视神经乳头改变。应用OCT可以检测到相关的变化。

Objective To detect the changes in the retinal nerve fiber layer （RNFL） and ganglion cell complex （ GCC ） in the eyes of multiple sclerosis patients during the early stage of optic neuritis. Methods A prospective case series study. Suspected acute optic neuritis of multiple sclerosis （MS） patients who attended the department of ophthalmology in Peking Union Medical College hospital from Feb. 2007 to Nov. 2010 were collected. Twenty two MS patients were evaluated within the first week of the attack of acute optic neuritis. The average thickness of RNFL and GCC was measured and a three dimensional image of optic disk was reconstructed using optical coherence tomography （OCT）. Results Within the first week of onset, the average thickness of RNFL and GCC of first attack eyes increased 75% and 64% , respectively. The average thickness of RNFL and GCC in relapsed eyes decreased 91.7% and 62.5% respectively. The average thickness of RNFL and GCC of the fellow eyes also increased 60% and 43% respectively, within the first week of onset. More cases of optic disk edema and thickening of RNFL were found by OCT than by direct ophthalmoscopy. Conclusions Different changes of the thickness of RNFL and GCC and morphology of the optic disk were detected during the early stage of the initial attack or relapsed optic neuritis in MS patients. OCT could detect such differences.