前部缺血性视神经病变31例临床观察

Clinical observation of anterior ischemic optic neuropathy in 31 cases

目的:探讨前部缺血性视神经病变的发病因素、临床误诊及诊断治疗情况。方法:回顾性分析前部缺血性视神经病变31例37眼的发病特点,视野和眼底荧光素血管造影的表现以及治疗预后情况。结果:经治疗视力改善26例(84%)。眼底荧光素血管造影早期视盘全部或部分荧光充盈延缓或缺损,伴有相应的视野缺损,造影晚期视盘荧光形态有多种表现形式。结论:中老年的糖尿病、高血压和(或)动脉硬化患者是前部缺血性视神经病变的高危人群,其诊断应综合考虑临床症状、视野和眼底荧光素血管造影检查结果。临床误诊率高,应注意和其他视神经疾病鉴别。治疗应首先控制原发病变,结合全身及局部应用糖皮质激素、扩血管药物、能量合剂、维生素类药物等。非颞动脉炎引起者应用复方樟柳碱注射液治疗,可有效改善视网膜循环,提高视力。

AIM： To explore the cause, clinical diagnosis and treatment and misdiagnosis of anterior ischemic optic neuropathy（AION）. METHODS： The pathogenesis characteristics, vision, fundus fluorescein angiography performance and the treatment situation of anterior ischemic optic neuropathy was analyzed retrospectively in 31 cases （37eyes）. RESULTS： The visual acuity of 26 cases （84%） improved. In the early stage of Fundus fluorescein angiography, fluorescence filling of the optic disc was delayed or waned with the corresponding visual field defect. Advanced fluorescence imaging shape of the optic disc was manifested in many forms. CONCLUSION： Patients with elderly diabetes, hypertension and （or） atherosclerosis are high-risk group of people with ischemic optic neuropathy. Doctors should considered clinical symptoms, vision and fundus fluorescein angiography results at the time of diagnosis comprehensively. The rate of clinical misdiagnosis was high, and we should pay attention to the differential diagnosis of other optic nerve disease. Before treatment, primary lesions should be controlled and treated, and the local or systemic application of glucocorticoid, vasodilator drugs, energy mixture, vitamins and drugs should be promoted. Compound anisodine hydrobromide Injection can effectively improve the retinal circulation and eyesight in patients with non-temporal arteritis.