白血病所致视神经浸润的临床观察

Leukemic infiltration of optic nerve

目的 探讨白血病所致视神经浸润的临床特点。方法 收集2006年1月至2014年6月于云南省第二人民医院眼科确诊为白血病视神经浸润的23例患者,排除高血压、糖尿病、颅内高压等造成视神经损伤的全身及局部疾病。根据眼底病变的特征分为两种类型：（1）单纯视盘水肿;（2）视盘水肿合并出血渗出性病变。结果 23例患者中9例18眼表现为单纯视盘水肿,眼底彩色照相可见患者视盘水肿,呈不同程度隆起,边界不清楚,严重者高达3-4个屈光度,视盘表面小毛细血管扩张、充血明显。眼底荧光血管造影显示：荧光造影早期视盘表面血管扩张,通透性增加,出现荧光素渗漏,晚期视盘着染呈强荧光。23例患者中14例28眼表现为视盘水肿出血合并视网膜血管异常,眼底彩色照相极似急性视网膜坏死样改变,可见视盘肿胀、苍白,边界模糊,视盘表面及周围视网膜散在点片状出血点;视盘周围视网膜苍白水肿,视网膜动脉呈白线样浸润,静脉迂曲扩张;后极部散在不同程度出血及白色浸润灶,并累及黄斑区。眼底荧光血管造影：视盘表面血管扩张,通透性增加,出现荧光素渗漏,晚期视盘着染呈强荧光,视网膜静脉迂曲扩张、出血区域遮蔽荧光。结论 单纯视盘水肿和视盘水肿合并出血渗出性病变是白血病所致视神经浸润的两种主要表现。眼科临床医师应加强对该病的认识,积极寻求有效的治疗手段。

Objective To discuss the clinical characteristic of leukemic infiltration of optic nerve.Methods Twenty-three patients of leukemic optic nerve infiltration from January2006 to June 2014 in the Second People＇s Hospital of Yunnan Province were collected,hypertension,diabetes,intracranial pressure in systemic and local diseases were excluded.According to retinopathy characterized into two types：one was pure optic disc edema,the other was optic disc edema with hemorrhagic exudative lesions.Results Nine cases（18 eyes） showed simple optic disc edema,retinal color photo showed optic disc edema with varied degrees uplift,the border was not clear,serious patients were up to 3 to 4 diopters,small capillaries on the optic disc surface expanded and congested significantly.Fundus fluorescein angiography revealed that the vessels on the disc surface expanded at the early fluorescein angiography,the permeability of fluorescein leakage increased,the leakage of fluorescein appeared,and the angiography procedure to the late disc fluorescence staining was strong.14 cases（28 eyes）showed optic disc edema and hemorrhage with retinal vascular abnormalities,fundus photography changes was similar with acute retinal necrosis,the optic disc swollen and paled with fuzzy boundaries,the retinal haemorrhage points scattered on the surface and around the optic disc;The retina around the optic disc was paled and edema,retinal artery was white line like infiltration,varices expanded,different degrees of bleeding and white infiltrates scattered at the posterior pole,and involved the macula.Fundus fluorescein angiography showed that the vessels on the disc surface expanded with increased permeability,the leakage of fluorescein was seen,the late disc fluorescence staining was strong,the retinal vein circuitous and expanded,bleeding area covered fluorescent.Conclusion The simple disc edema and optic disc edema with hemorrhagic exudative lesions caused by leukemia infiltration are the two main manifestations of leukemic optic nerve infiltration.Ophthalmology clinicians should strengthen the awareness of the disease and actively seek for effective treatment.