经鼻内镜筛蝶窦视神经管减压术治疗急性球后视神经炎效果

CURATIVE EFFECT OF OPTIC NERVE CANAL DECOMPRESSION ON ACUTE RETROBULBAR NEURITIS UNDER NASAL ENDOSCOPE SURGERY

目的观察经鼻内镜筛蝶窦视神经管减压术治疗急性球后视神经炎的效果。方法选择经眼科药物治疗16～20d后疗效欠佳的急性球后视神经炎病人10例12眼（其中8例单眼,2例双眼）,行鼻内镜视神经管减压术治疗,观察治疗结果。结果 4例4眼术后1～2d患眼视力由术前无光感达到光感,3～5d增进到2～3m数指,6～15d视力可达0.2～0.5,15～30d视力达到0.5～0.8。6例8眼术后1～2d视力达到60cm数指,3～5d达到0.1,6～15d视力0.3～0.5,15～30d视力达到0.5～0.8。术后15～30d复查眼眶CT及眼眶MRI,病人视神经增粗现象消失,异常强信号减弱。随访观察显示,10例病人视力恢复到0.8左右,眼底呈正常状态。结论经鼻内镜筛蝶窦视神经管减压术治疗急性球后视神经炎效果好,安全性高。

Objective To observe the efficacy of optic nerve canal decompression on acute retrobulhar neuritis （ARN） under nasal endoscope surgery. Methods Ten patients with ARN-12 eyes, of which, single eye involved in eight patients, both eyes in two-were enrolled, after 16--20 d of ophthalmological drug therapy without good effects, an optic nerve canal decompres- sion was performed under nasal endoscope surgery. Results The sight of four eyes in four patients improved from no light per- ception before surgery to light perception 1--2 d after surgery, from 2-3 m counting-fingers in 3-5 d, in 6-15 d, the sight reached to 0.2-0.5, and after 15-30 d, it reached 0.5-0.8. The visual acuity of six patients （8 eyes） reached 60cm counting fin- gers 1-2 d after surgery, it reached 0.1 in 3-5 d, 0.3-0.5 in 6-15 d, and 0.5-0.8 in 15-30 d. A review of orbit CT and MRI done 15-30 d after surgery showed that optic nerve enlargement disappeared, abnormally strong signal weakened. A follow-up in- dicated the sight in ten patients recovered to 0.8, with normal eyeground. Conclusion Optic nerve canal decompression under nasal endoscope surgery for acute retrobulbar neuritis is effective and safe.