不同临床类型特发性视神经炎的视野损害特点研究

Characteristics of visual field damage in different clinical types of idiopathic optic neuritis

目的 明确特发性视神经炎（ION）的视野损害特点及其与是否复发的关系。方法 收集2010年8月~2013年7月同仁医院神经眼科病房住院的ION患者，将患者Humphrey视野检查结果结合预后进行分析。结果 共入组ION患者225例，共337眼受累，其中多发性硬化相关视神经炎（MS-ON）72例（32%）、视神经脊髓炎相关视神经炎（NMO-ON）50例（22.2%）、孤立性视神经炎（SION）37例（16.4%）、复发性视神经炎（RION）66例（29.3%）；视野改变：弧形暗点10眼（3%）、水平型视野缺损25眼（7.4%）、中心暗点33眼（9.8%）、旁中心暗点8眼（2.4%）、阶梯视野缺损3眼（0.9%）、生理盲点扩大3眼（0.9%）、象限盲25眼（7.4%）、周围性缺损42眼（12.5%）、弥漫性缺损173眼（51.3%）、正常视野15眼（4.5%）；MS-ON与NMO-ON、RION相比视野改变差异有统计学意义（P值为0.003、0.002），而MS-ON与SION、NMO-ON与RION、RION与SION的视野改变相比差异均无统计学意义（P值分别为0.227、0.112、0.575）。结论 ION的视野改变多种多样，本组ION的视野改变以弥漫性视野缺损最为常见。不同临床亚型的ION具有一定的局灶性视野缺损特点，在ION急性期明确视野缺损类型对于ION不同临床亚型的鉴别诊断具有一定的意义。

Objective To describe the characteristics of the lesion of vision field and to evaluate the relationship between the lesion of vision field types and recurrence in idiopathic optic neuritis（ION） patients. Methods ION in-patients in Tongren Hospital, Department of Neuro-Ophthalmology were enrolled during Aug 2010 to July 2013.Humphrey perimetry vision fields were collected for each patient and evaluated combining with prognosis. Results Two hundred and twentyfive patients （337 eyes） with ION were included in the study. Seventy-two cases （32%） were diagnosed as multiple sclerosis related optic neuritis（MS-ON）, 50 cases （22.2%） were neuromyelitisoptica related optic neuritis（NMO-ON）,37 cases （16.4%） were solitary isolated inflammatory optic neuritis（SION） and 66 cases （29.3%）were recurrent inflammatory optic neuritis（RION）.Visual field changes showed that arcuate scotoma was seen in 10 eyes （3%）, altitudinal visual field defects in 25 eyes （7.4%）, central scotoma in 33 eyes （9.8%）, paracentrol scotoma in 8 eyes （2.4%）, step visual field defect in 3 eyes （0.9%）, enlarged blind spot in 3 eyes （0.9%）, quadrant blind in 25 eyes （7.4%）, peripheral field defects in 42 eyes （12.5%）, diffuse defects in 173 eyes （51.3%） and the normal field of vision in 15 eyes （4.5%）. There was significant difference between MS-ON and NMO-ON, RION（P=0.003, 0.002）, but not between MS-ON and SION,NMO-ON and RION,RION and SION （P=0.227, 0.112, 0.575） on visual field changes. Conclusions Vision changes were varied in ION patients. Diffuse defects were the most common type in ION patients. There were some focal characteristics of visual field defects in different clinical subtypes of ION. It was important to distinguish different clinical subtypes of ION in the acute phase of ION by explicating the type of visual field defect.