神经眼科学最新研究

Recent developments in neuro-ophthalmology

本文回顾了神经眼科学在临床试验、诊断性检测及新的疾病分型例如视神经脊髓炎谱系病(NMOSD)等方面的研究进展,详尽总结了特发性颅内高压、Leber遗传性视神经病变及视神经胶质瘤等疾病的临床试验最新成果。Leber遗传性视神经病变的基因治疗效果令人振奋,可能在未来几年内产生重大的临床影响力。近年来光相干断层扫描(OCT)及光相干断层扫描血管成像(OCTA)在神经眼科的疾病诊疗中发挥了重要作用,OCT不仅可对视神经病变进行辅助诊断,用于视神经炎、缺血性视神经病变、视交叉压迫病变的诊断和治疗过程监测,而且对视交叉以后的视路病变的诊断也有较大的参考价值。最新研究也表明,借助于OCTA检查可发现,急性期缺血性视神经病变(NAION)或视神经炎患者视盘血管密度是增加的,而严重视盘水肿和不同原因视盘萎缩的患者视盘血管密度则是降低的。眼科医生应该关注这些视神经疾病诊疗方面的最新进展。

Some recent advances in neuro-ophthalmology including clinical trials,diagnostic testing and newly elucidated disease entitites were summarized in present paper,such as neuromyelitis optica spectrum disorder.The review goes into great detail regarding recent clinical trials in neuro-ophthalmology.These trials have investigated the management of idiopathic intracranial hypertension as well as treatment of Leber hereditary optic neuropathy and optic nerve glioma.The potential gene therapy for Leber hereditary optic neuropathy seems very promising and may have a significant clinical impact within the next few years.This review also includes an extensive discussion about the application of optical coherence tomography (OCT) and OCT-angiography (OCTA) in neuro-ophthalmology.OCT has important clinical relevance not only for the diagnosis and management of optic neuropathies,such as optic neuritis,ischemic optic neuropathy and chiasmal compression,but also for retro-chiasmal injury.In terms of OCTA,recent studies have demonstrated increased vessel density in acute stage of ischemic optic neuropathy (NAION) and optic neuritis,but decreased vessel density in severe papilloedema and late stage of optic atrophy of any cause.These serve as the potential foundation for future clinical applications.Ophthalmologists should pay more attentions to these recent progress in neuro-ophthalmology.