视神经炎黄斑区神经节细胞复合体及视盘周围神经纤维层损伤演变过程的临床观察

Clinical observation on the evolution process of macular ganglion cell complex and peripapillary retinal nerve fiber layer of neuritis patients

目的 探讨视神经炎患者黄斑区节细胞复合体（mGCC）及视盘周围神经纤维层（pRNFL）的动态变化.方法 回顾性系列病例研究.收集2013年6月至2015年6月在北京中日友好医院眼科诊断为视神经炎且规律复诊的患者11例（11只眼）,其中男性4例,女性7例,平均年龄（40.4±14.1）岁.分析患者的相干光层析成像术（OCT）检查结果,观察mGCC和pRNFL随病程进展的变化特点及与视力、视野的对应关系.结果 11只视神经炎患眼发病初期（亚正常眼期）视力下降、视野异常,OCT检查结果可见mGCC和pRNFL肿胀,表现为厚度正常高限或部分超出高限;3周左右进入分离现象期,mGCC变薄,pRNFL仍然肿胀;6～8周后进入萎缩期,mGCC和pRNFL均变薄.经过治疗视力和视野较初发期均可好转,但无法恢复至原有水平.结论 视神经炎患者随病程进展mGCC和pRNFL厚度改变不尽相同,OCT可以探测到这些改变,进而为探讨视神经炎的治疗和结构改变提供基础.

Objective To discuss the dynamic changes and correlation of macular ganglion cell （mGCC） and peripapillary retinal nerve fiber layer （pRNFL） of neuritis patients through optical coherence tomography （OCT）.Methods A retrospective case series study.Eleven eyes from 11 patients who have been diagnosed with neuritis and received regular follow-up during June 2013 through June 2015 were included.The dynamic characteristic changes of mGCC and pRNFL over the course of disease,as well as their correlations between best visual acuity and visual field have been analyzed based on OCT measurements.Results According to the observation on the 11 eyes of the 11 patients,patients showed symptoms of decreased vision,abnormal visual field,swollen mGCC and pRNFL with normal or increased thickness during the subnormal period.During the advance-separation period （around 3 weeks）,the thickness of mGCC decreased resulting from atrophy while pRNFL was still swollen.Druing the late period （usually 6-8 weeks after onset of the disease）,both mGCC and pRNFL were getting thinner due to atrophy.Vision acuity and visual field of the patients improved after treatment,however,they were still not comparable with the normal level before the disease.Conclusions The thickness changes of mGCC and pRNFL differs in neuritis patients over time.OCT can help us in detecting these changes,thus provide a foundation for us to further explore the treatment and anatomical changes of neuritis patients.