非动脉炎性前部缺血性视神经病变缺血部位和程度的评估及病因探讨

Evaluation of ischemic site and degree as well as etiological factor of nonarteritis anterior ischemic optic neuropathy

目的:探讨非动脉炎性前部缺血性视神经病变(nonarteriticanterioris-chemicopticneuropathy,NAION)的临床特征。方法:分析广州医学院第二附属医院眼科2000-01/2003-01已确诊的NAION患者72例(80眼),男39例(44眼),女33例(36眼);单眼发病64例(89%),双眼发病8例(11%)。排除标准:所有患者均无巨细胞性动脉炎的表现。纳入标准:病史、症状、眼底、视野、FFA结果均符合NAION的诊断标准。经视力、视野、眼底和荧光眼底血管造影(flouresceinfundusangiography,FFA)等检查确诊的前部缺血性视神经病变72例(80眼)的临床资料进行分析。结果:72例中伴有高血压动脉硬化28例(30眼),伴有糖尿病20例(24眼),伴高血脂症14例(15眼),青光眼4例(5眼),白内障术后2例(2眼),原因不明4例(4眼)。眼底视盘水肿色淡,其中呈象限性水肿21眼,半侧水肿19眼,全视盘水肿28眼,无水肿12眼。FFA早期视盘全部或部分荧光充盈延缓或缺损,显示缺血的部位和范围;晚期荧光充盈各异,缺血区呈强荧光或弱荧光,其中主要为强荧光,有68眼(85%),多见于病程较短者;视盘持续弱荧光者12眼(15%),见于病程较长者。FFA显示缺血累及的部位和范围伴有相应视野缺损者60眼(75%)。结论:前部缺血性视神经病变是一种多因性眼病,而高血压、视网膜动脉硬化、糖尿病、高血脂症?

AIM:To investigate the clinical features of nonarteritic anterior ischemic optic neuropathy(NAION). METHODS:Clinical data of 72 patients(80 eyes) with NAION in the Department of Ophthalmology,Second Affiliated Hospital of Guangzhou Medical College during January 2000 to January 2003,39 males(44 eyes) and 33 females(36 eyes),were analyzed.Among them,64 patients had ocellus disease(89%) and 8 patients with oculus uterque(11%).Exclusive criteria:All the patients had no symptoms of giant cell arteritis.Inclusive criteria:ill history,symptom,fundus,visual field and fluorescence fundus angiography (FFA) results were all in accordance with diagnosis criteria of NAION. Clinical data of 72 patients(80 eyes) who had been diagnosed to have anterior ischemic optic neuropathy by view,visual field, fundus and FFA were analyzed. RESULTS:Of the 72 patients,28(30 eyes) were accompanied with hypertension arteriosclerosis,20(24 eyes) accompanied with diabetes,14 (15 eyes) accompanied with hyperlipemia,4(5 eyes) accompanied with glaucoma,2(2 eyes) were accompanied with post-operation cataract and 4(4 eyes) had unknown reasons.Fundus papilloedema showed light color, among them,21 eyes were quadrant edema,19 eyes showed edema of half optic disc,28 had edema of all optic disc,and 12 had no edema.At the early stage of FFA,all optic disc or parts of fluorescence filling were delayed or defected,and showed the defect positions and ranges.At the later stage, fluorescence filling was various;the defect positions were stronger or weaker fluorescent light,mainly the stronger, including 68 eyes(85%),with shorter courses.Otherwise,the continuous weaker was often seen in the longer course,including 12 eyes(15%).The ischemic sites and ranges in 60 eyes(75%) showed by FFA had visual defects correspondingly. CONCLUSION:NAION is a ophthalmocace caused by multiple factors,and the dominant factors are hypertension,artery sclerosis of retina,diabetics and hyperlipemia.Ischemic sites and corresponding visual defect detected by FFA are main diagnostic evidences of this disease.