非动脉炎性前部缺血性视神经病变诊治分析

Analysis of the diagnosis and treatment of nonarteritic anterior ischemic optic neuropathy

目的 探讨非动脉炎性前部缺血性视神经病变（NAION）患者的临床特征、发病危险因素和治疗效果。方法 采用临床病例回顾性系列研究。自2011年4月至2015年6月间，在天津市第四中心医院眼科连续收治NAION患者43例（49只眼），分析其临床表现、眼部及全身危险因素和荧光素眼底血管造影（FFA）结果，应用糖皮质激素、血管扩张剂和神经营养剂进行治疗，并比较治疗前后的矫正视力和视野变化。结果 43例患者平均年龄为（57.9±10.6）岁，男女之比为1.5：1。所有患者均表现有不同程度的中心视力下降和视野改变，其中与生理盲点相连的象限性缺损23只眼（46.9%），眼底检查可见患眼视乳头缺血水肿44只眼（89.8%），FFA检查早期可见视乳头血管充盈迟缓和晚期荧光增强者32只眼（65.3%）。伴发的全身疾病包括高血压病（30例，69.8%）、高脂血症（25例，58.1%）和糖尿病（12例，27.9%）。经扩张血管和营养神经药物综合治疗后患眼视力提高者28只眼，有效率为57.1%；视野缺损改善者为31只眼，有效率为63.3%。FFA示早期视盘充盈时间较前缩短者11只眼，缺血范围较前缩小者27只眼。结论 NAION是一种与多种全身疾病相关的多因素致病的眼部病变，高血压病、糖尿病、高脂血症或动脉硬化是其主要危险因素。经积极综合治疗后，患者中心视力和视野均有一定改善。

Objective To explore the clinical characteristics, risk factors and efficacy of treatment in patients with non-arteritic anterior ischemic optic neuropathy （NAION）.Methods The retrospective series research of clinical cases were used for this study. From April 2011 to June 2015, forty-three cases （49 eyes） of NAION patients were collected continuously in the Forth Central Hospital of Tianjin City. The clinical characteristics, risk factors and the fundus fluorescein angiography （FFA） features were analyzed retrospectively. The systemic corticosteroids, vasodilator and nerve nutritional agent were used for treatment. The results of corrected visual acuity or visual fields were compared before and after the treatment.Results The average age of 43 cases of patients was 57.9±10.6 years old. The male and female ratio was 1.5：1. All the patients had the visual acuity impairment and visual defect, the quadrant defect connected with the physiological blind spot which was not involved the central point of regard was common （23 eyes, 46.9%）. The fundus changes were swallow of optic disc in 44 eyes （89.8%）. The early phase of FFA examination showed delayed filling and hyperfluorescein at late phase in 32 eyes （65.3%）. The associated systemic diseases were systemic hypertension （30 cases, 69.8%）, hyperlipidemia （25 cases, 58.1%） and diabetes mellitus （12 cases, 27.9%）. After the intensive treatments, the visual acuity of the patients had improvement in 28 eyes, the improvement rate was 57.1%; the visual fields had improvement in 31 eyes, the improvement rate was 63.3%. The early phase of FFA examination showed the filling time was shorter than before in 11 eyes, and the ischemic range reduced in 27 eyes.Conclusions The pathogenesis of NAION is caused by multi-factors and usually associated with many systemic diseases. Systemic hypertension, diabetes mellitus, hyperlipidemia or arteriosclerosis are the main risk factors. After active treatments, the visual acuity and visual fields are often improved.