视神经炎的临床特征分析及早期视盘和黄斑的改变

Clinical characteristics analysis of optic neuritis and the changes in early optic disc and macula lutea

目的研究视神经炎患者的临床特征及早期视盘和黄斑的改变。方法回顾性分析山西省眼科医院视神经炎患者67例85眼。分析患者基本情况、眼科检查结果及OCT检查结果。结果 67例85眼中,男24例,女43例;28例(41.8%)发生于冬季;49眼(57.6%)入院时最佳矫正视力小于1.7 logMAR。视神经脊髓炎抗体阳性者出院和入院时的最佳矫正视力均较髓鞘少突胶质糖蛋白抗体阳性者差。患眼较健眼视盘周围神经纤维层增厚,杯盘面积比、杯盘垂直比、杯盘水平比、杯容积减小,盘沿面积、视盘面积增大(均为P=0.000);与健眼相比,患眼早期上方、下方和平均黄斑区神经节细胞层厚度及黄斑区神经节细胞复合体的局部丢失体积、整体丢失体积均未发生明显改变(均为P>0.05)。视盘水肿与患眼平均视盘周围神经纤维层厚度存在正相关(r=0.728,P=0.000)。结论视神经炎多发生于女性,早期视力损害严重,视神经脊髓炎抗体阳性者视力预后差。早期由于视盘水肿,视盘周围神经纤维层增厚,盘沿面积、视盘面积增大;杯容积、杯盘比减小,早期病变未累及黄斑区。

Objective To study the clinical features,early changes in optic disc and macula lutea in optic neuritis (ON) patients. Methods We retrospectively reviewed eighty-five eyes of 67 patients with ON in Shanxi Eye Hospital.The analysis included basic information,ophthalmological examination results and OCT. Results In 67 patients,24 males and 43 females,28 patients (41.8%) occurred in winter,and 49 eyes(57.6%) with best corrected visual acuity under 1.7 logMAR at first.Patients with positive neuromyelitis optica(NMO)antibody had a worse visual acuity than patients with positive myelin oligodendrocyte glycoprotein antibody.Compared with healthy eyes,in injured eyes,the per-papillary retinal fiber layer (pRNFL) thickness were thicker;the cup-to-disk area ratio,vertical and horizontal ratio and cup volume were smaller;the rim area and disk area were increased (all P =0.000).Both the thickness of superior,inferior,and average macular ganglion cell layer (mGCL) and focal and global loss volume of macular ganglion cell complex (mGCC) had no significant differences between two groups in the early phase (all P >0.05).The optic disc edema had a positive correlation with the thickness of pRNFL in injured eyes( r =0.728, P =0.000). Conclusion The female has a tendency to ON.ON has a serious visual impairment at beginning and a poor visual prognosis in patients with positive NMO antibody.Due to optic disc edema,pRNFL increase,and the rim and disk area expand,accordingly,while the cup volume and cup-to-disk ratio decrease.The lesion has not spread macula lutea in early stage.