空蝶鞍综合征眼部特征分析

The ocular appearance of empty sella syndrome

目的探讨空蝶鞍综合征的眼部临床表现及预后。设计回顾性病例系列。研究对象在北京同仁医院就诊，经MRI检查诊断为空蝶鞍综合征的32例患者。方法对这些患者的检查治疗资料及眼部表现进行分析。主要指标视力、眼压、眼底、视野、房角。结果32例患者中因明显视力下降就诊者20例（62．5％）。最佳矫正视力低于0．8者45眼，其中低于0．1者5眼，0．1～0．3者14眼，0．4～0．7者26眼。眼压在21～29mmHg者13眼（20．3％）。眼底检查13眼（20．3％）有视盘水肿，191~（29．7％）有视神经萎缩。视野缺损48眼（75．0％），其中9眼有类似青光眼的视野缺损，10例患者为双颞侧偏盲。房角开放者28例56眼（87．5％），房角窄或可疑关闭者4例8眼（12．5％）。3例空蝶鞍综合征患者合并闭角型青光眼，1例合并开角型青光眼，2例合并正常眼压性青光眼。3例患者经神经外科手术治疗，最佳矫正视力好转。结论空蝶鞍综合征的眼部表现可有视力下降、视盘水肿、视神经萎缩及视野缺损。对于不能由眼科疾病解释而怀疑本病者，应及时请相关科室会诊并协助治疗。

Objective To analyze the ocular appearance of primary empty sella syndrome （ESS） patients. Design Retrospective case series. Participants 32 patients diagnosed as empty sella and partial empty sella after brain MRI examination in Beijing Tongren Hospital. Methods All patients underwent ocular examination, and the ocular characteristics of patients were analyzed. Main Outcome Measures Visual acuity, intraocular pressure （IOP）, fundus, visual fields, angle of anterior chamber. Results In the 32 patients, a chief complaint of blurred vision happened in 20 cases. The best corrected visual acurity （BCVA） was less than 0.8 in 45 eyes, and among these 45 eyes, BCVA less than 0.1 in 5 eyes, 0.1-0.3 in 14 eyes, 0.4-0.7 in 26 eyes. In 13 eyes （20.3%）, the IOP varied from 21to 29 mm Hg. Papillary edema was found in 13 eyes（20.3%）. Optic nerve atrophy was found in 19 eyes（29.7%）. Among the 48 eyes （75.0%）whieh had visual field defeet, 9 eyes had similar visual field defect with glaueoma. Bitemporal hemianopia was found in 10 cases. 28 eases had wide or open angle. 4 eases had narrow or closed angle. We found ESS combined with primary angle elosed glaucoma in 3 eases, with primary open angle glaueoma in 1 eases, with normal tension glaueoma in 2 eases. BCVA of 3 ESS patients progressed after operation of neurosurgery. Conclusions The findings indicate the ocular appearance of empty sella syndrome eould be deereased visual acuity, optic disc edema, optic nerve atrophy, and visual field defeet. If the clinical appearance eould not be explained by eye disease and suspected the ESS, we should discuss with neurologist for denifite diagnosis and treatment.