糖尿病视网膜病变合并前部缺血性视神经病变的眼底及临床特征

Clinical features of the ocular fundus with diabetic retinopathy combined anterior ischemic optic neuropathy

目的 观察糖尿病视网膜病变 (DR)合并前部缺血性视神经病变 (AION)的眼底血管造影 (FFA)和临床特征。方法 回顾分析 16 18例DR合并AION 17例患者的FFA检查结果、视力、视野、VEP等相关的临床资料。结果 17例患者中双眼同时出现AION 1例 ,双眼先后出现AION 1例 ,其余为单眼 ,其中右 11眼 ,左 4眼。FFA表现为 :患眼视盘始终低荧光或早期出现区域性低荧光或充盈迟缓 ,后期荧光素渗漏。单眼发病 15例中 ,有 6例患者双眼底DR的分级一致 ,另外 9例患者DR的改变为 :合并AION眼的DR分级低于无AION的眼。双眼先后发病的 1例患者 ,先发病眼的DR分级低于后发病眼。所有病人均有不同程度视力损害 ,但视野出现损害者仅有 10人 ,表现为与生理盲点相连的束状或扇形视野缺损 ,视觉诱发电位(VEP)出现异常者有 11人。结论 DR合并AION的患眼 ,其眼底DR改变常轻于无AION的患眼 ,说明眼底血流量的减少可能对DR的发展起保护或抑制性作用。

Objective To investigate the clinical fe atures of the ocular fundus with diabetic retinopathy combined anterior ischemic optic neuropathy. Methods Fundus charactaristics of FFA and others related clinical data(vision, visual field, VEP, etc) were retrospectively analysed in 17 patients diagnosed as DR combined AION among 1 618 DR patients. Results In 17 patients, AION occurred in 4 eyes (21.05%) of 2 patients at the different and same time respectively, and single eye including of 11 right eyes (57 89%) and 4 left eyes (21.05%) occurred in other patients. FFA showed that disc had no perfusion of fluorescein or had low fluorescein or engorged slowly. In the later stage, disc leakaged fluorescein. Among 15 single-eye patients, there were 6 patients with same DR changes of the ocular fundus at both eyes, and 9 patients with different DR changes of the ocular fundus at both eyes. Patients with DR combined with AION were lighter than those with DR without AION. The vision impairment occurred in all patients but visual field impairment (fan-shaped or bundle-shaped impairment of visual field linking Disc) was only in 10 eyes (52.63%). The abnormal VEP occurred in 11 eyes (57.89%). Conclusion Manifestations of patients with DR with AION were lighter than those without AION,suggesting that the decrease of disc blood supplement can protect or inhibit the progress of DR.