367例眼底内科住院患者无光感眼病种构成及视力恢复情况

Etiologies and vision outcomes of 367 inpatients with no light perception

目的观察眼底内科住院的非手术和外伤的无光感眼病种构成及其视力恢复情况。方法在眼底内科住院治疗的无光感患者367例430只眼纳入研究。所有患者经暗室手电光检查结合瞳孔对光反射检查确定视力为无光感。其中，男性208例235只眼，女性159例195只眼。双眼63例126只跟，单眼304例304只眼。单眼患眼中，右眼159只，左眼145只。年龄2．50～86．OO岁，平均年龄（40．85±18．03）岁。观察患眼的病种构成。针对不同病种对患者进行相应治疗，观察出院时患者的视力恢复情况。结果430只患眼中，视神经炎157只眼，占36．5oA；葡萄膜炎68只眼，占15．8％；视网膜血管性疾病54只眼，占12．6％；缺血性视神经病变35只眼，占8．1％；外伤性视神经病变29只眼，占6．7％；视神经萎缩28只眼，占6．5％；眼球外伤18只眼，占4．2％；放射性视神经病变17只眼，占4．0％；青光眼10只眼，占2．3％；视网膜脱离5只眼，占1．2％；压迫性视神经病变4只眼，占0．9％；眶尖综合征2只眼，占0．5％；癔症2只眼，占0．5％；眶蜂窝织炎1只眼，占0．2％。经住院积极治疗后，视力仍为无光感269只眼，占62．6％；视力恢复至光感及以上161只眼，占37．4％。视力恢复至光感及以上的161只眼中，视力光感～〈0．02者74只眼，占总患眼的17．2％；≥0．02～〈0．05者25只眼，占总患眼的5．8Voo；≥0．05～〈0．1者14只眼，占3．3％；≥0．1～〈O．3者11只眼，占2．6％；≥0．3者37只眼，占8．6％。结论非手术和外伤的无光感眼主要为累及视网膜和视神经的病变所致。经积极住院治疗后可使部分患眼视力恢复至光感及以上。

Objective To observe the etiologies and vision outcomes of inpatients with no light perception （NLP）. Methods A total of 367 inpatients （430 eyes） with NLP in Zhongshan Ophthalmic Center were enrolled in this study. The visual acuity examination followed the international standard methods. NLP was detected by torch light in a dark room and the pupil light reflection state was also considered. The patients included 208 males （235 eyes） and 159 females （195 eyes）. Sixty-three patients （126 eyes） were bilateral and 304 patients （304 eyes） were unilateral cases including 159 right eyes and 145 left eyes. The patients＇ ages ranged from 2.5 to 86.0 years, with a mean age of （40.85±18.03） years. All the patients were treated according to their diseases. The ratio of different eye disease and visual outcome were recorded and analyzed. Results Among 430 eyes, there were 157 eyes （36.5%） with optic neuritis, 68 eyes （15.8%） with uveitis, 54 eyes （12.6%） with retinal vascular disease, 35 eyes （8.1%） with ischemic optic neuropathy, 29 eyes （6.7%） with traumatic optic neuropathy, 28 eyes （6.5M） with optic atrophy, 18 eyes （4.2%） with trauma, 17 eyes （4.0%） with radiation optic neuropathy, 10 eyes （2.3%） with glaucoma, five eyes （1.2%） with retinal detachment, four eyes （0.9%） with compressive optic neuropathy, two eyes （0.5%） with orbital apex syndrome, two eyes （0.5%） with hysteria, and one eye （0.2%） with orbital cellulitis. After active treatment, 269 eyes （62.6%） remained NLP, 161 eyes （37.4%） got improved visual acuity, including light perception- 0.02 in 74 eyes （17.2%）,≥0.02 - 〈 0.05 in 25 eyes （5.8%）, ≥0.05 - 〈0.1 in 14 eyes （3.3%）, ≥0.1 - 〈0.3 in 11 eyes （2.6%） and ≥0.3 in 37 eyes （8.6%）. Conclusions The main causes of nonsurgical and nontrauma NLP are retinal disease and optic neuropathy. Some patients with NLP may restore useful vision if they received prompt referral and active intervention.