非动脉炎性前部缺血性视神经病变患眼脉络膜厚度观察

The choroidal thickness in patients with nonarteritic anterior ischemic optic neuropathy

目的观察非动脉炎性前部缺血性视神经病变（NAION）患眼黄斑中心凹下脉络膜厚度（SFCT）、视盘旁脉络膜厚度（pCT），初步探讨其与视力的关系。方法初发NAION患者19例纳入研究。将患者的患眼、对侧眼分别设为A、B组，分别为19例20只眼和18例18只眼。选取同期年龄、性别、眼压、眼轴长度（AL）匹配的正常人20名20只眼作为对照组（C组）。A、B组与C组受检者平均年龄（t=1．58）、性别构成比（矿=o．107）比较差异无统计学意义（P〉0．05）；受检眼平均眼压（t=-0．092）、AL（t=-0．148）比较，差异无统计学意义（P〉0．05）。采用频域光相干断层扫描增强深部成像技术测量受检SFCTCT、pCT。A、B组受检眼治疗后1、3个月采用相同设备和方法重复上述检查。观察初诊时3组受检眼之间SFCT、pCT差异；最小分辨角对数（10gMAR）最佳矫正视力（BCVA）与SFCT、pCT的关系。治疗后1、3个月，A、C组受检眼SFCT、pCT的差异。分析logMAR BCVA与脉络膜厚度的关系。结果初诊时，A组患眼平均SFCT、pCT较C组受检眼显著增厚，差异有统计学意义（t=2．957、2．844，P=0．006、0．009）。B、C组受检眼平均SFCT、pCT比较，差异均无统计学意义（t=2．019、2．024，P=0．053、0．057）。相关性分析结果显示，logMARBCVA与SFCT、pCT无相关（F=0．161、0．033，P=-0．695、0．859）。治疗后1个月，与C组受检眼比较，A组患眼SFCT仍显著增厚，差异有统计学意义（t=2．803，P=0．009）；pCT降低，差异无统计学意义（t=1．871，P=0．084）。治疗后3个月，与C组受检眼比较，A组患眼SFCT、pCT差异均无统计学意义（t=-1．223、1．105，P=0．236、0．282）。结论NAION患眼早期SFCT、pCT明显增厚；后期pCT、SFCT逐渐下降，3个月后与对照组差异无显著性。视力与脉络膜厚度无相关。

Objective To observe the changes in subfoveal choroidal thickness （SFCT） and peripapillary choroidal thickness （pCT） in nonarteritic anterior ischemic optic neuropathy （NAION）. Methods Nineteen newly occurred NAION patients were included. The patients were divided into group A （20 affected eyes of 19 patients） and B （18 fellow eyes of 18 patients）. Twenty eyes of 20 age, gender, intraocular pressure and axial length-matched healthy volunteers （group C） were enrolled in this study. The differences of age （t=-1.58）, gender ratios （Z2=0.107）, intraocular pressure （t=-0.092） and axial length （t=-0.148） between 3 groups were not significant （P〉0.05）. SFCT, pCT were measured at first visit, 1 month and 3 months after treatment using enhanced deep imaging technique of spectral domain optical coherence tomography. The correlation of best corrected visual acuity （BCVA） and the choroidal thickness was investigated. Results At the first visit, the mean SFCT and pCT in group A were significant thicker than group C （t=-2.957, 2.844; P=-0.006, 0.009）. There was no difference of SFCT and pCT between group B and C （t=-2.019, 2.024; P=0.053, 0.057）. There was no correlation between BCVA and SFCT, pCT （F=0.161, 0.033; P=0.695, 0.859）. One month after treatment, SFCT in group A was still thicker than group C （t=-2.803, P=0.009）; while pCT was decreased in group A when compared to group C, but the difference was not significant （t=-1.871, P=-0.084）. Three months after treatment, the differences of SFCT and pCT were not significant between group A and C （t=1.223, 1.105; P=-0.236, 0.282）. Conclusions At first visit, SFCT and pCT in NAION eyes showed a significant increase when compared to normal eyes. One month later, pCT in NAION eyes decreased to normal. Three months later, both SFCT and pCT decreased. These findings may suggest that a thickened choroid is a clinical characteristic at acute stage in NAION eyes.