闪烁融合频率在鉴别视神经炎和非动脉炎性前部缺血性视神经病变中的价值

Preliminary exploration of critical flicker fusion frequency in differentiating optic neuritis from non-arteritic anterior ischemic optic neuropathy

背景作为一种新型的无创且操作简单的检查手段,临界闪烁融合频率(critical flicker fusion frequency,CFF)可动态反映人眼视功能变化情况。目的探讨CFF在鉴别视神经炎(optic neuritis,ON)与非动脉炎性前部缺血性视神经病变(nonarteritic anterior ischemic optic neuropathy,NAION)中的价值。方法收集2021年1-9月解放军总医院眼科确诊的ON患者资料。受检者行最佳矫正视力(best-correct visual acuity,BCVA)、视野、光相干断层扫描、闪光视觉诱发电位(flash visual evoked potential,F-VEP)、CFF检查,包括CFF-红色(rCFF)、绿色(gCFF)、黄色(yCFF)。按照本次病程分为<1个月、1~3个月、3~6个月、≥6个月,按照BCVA≥0.5、0.1~0.5、<0.1分为轻度、中度、重度。比较两组眼科检查结果,不同病程及不同视力损伤CFF差异,对单眼发病1个月内的患者行CFF差值和差比分析,对重度视力损伤的患眼,以受试者工作特征(receiver operating characteristic,ROC)曲线分析CFF在鉴别ON与NAION中的价值。结果共纳入69例ON患者(102只患眼,29只健眼),中位年龄31岁,50例女性;NAION患者58例(71只患眼,33只健眼),中位年龄50岁,25例女性。两组性别、年龄差异无统计学意义(P>0.05)。总体上,两组患者的健眼和患眼CFF(三色)值差异均无统计学意义(P>0.05)。按病程分层后:发病1个月内ON患眼较NAION患眼(三色)CFF值均偏低(P<0.05),3~6个月时则均高于NAION(P<0.05),余时间点二者CFF值无统计学差异(P>0.05)。单眼发病1个月内ON患眼的CFF差值及差比较NAION均偏大(P<0.05)。按疾病严重程度分层,重度视力损伤NAION患眼rCFF、gCFF较ON患眼偏低(P<0.05)。ROC分析显示,rCFF、gCFF、yCFF鉴别两组重度视力损伤患眼的AUC分别为0.75、0.76、0.74。结论对于单眼发病1个月内或症状严重的ON和NAION患者,行CFF检查对鉴别诊断有一定意义。

Background As a new noninvasive and simple subjective examination method,critical flicker fusion frequency(CFF)can dynamically reflect the changes of visual function of human eyes.Objective To explore the application of critical flicker fusion frequency(CFF)in differentiating optic neuritis(ON)from non-arteritic anterior ischemic optic neuropathy(NAION).Methods A cross-sectional study was performed in the Department of Ophthalmology,Chinese PLA General Hospital from January to September in 2021.Subjects underwent best-corrected visual acuity(BCVA),visual field,optical coherence tomography,flash visual evoked potential(F-VEP)and CFF examinations,including CFF for red(rCFF),green(gCFF),yellow(yCFF).The ophthalmic results of the healthy and affected eyes were compared.The affected eyes were divided into different subgroups:<1,1-<3,3-<6,and≥6 months according to disease course;mild,moderate,and severe visual impairment according to BCVA≥0.5,0.1-0.5,<0.1.And the CFF value of affected eyes were compared according to different subgroups in sequence.For patients with monocular involvement within 1 month onset,the difference value and difference ratio of CFF between the two groups were further analyzed.Moreover,for patients with severe visual impairment,the CFF threshold for differentiating the two groups was analyzed by receiver operating characteristic(ROC)curve.Results A total of 69 ON patients(102 affected eyes and 29 healthy eyes,50 females)with median age of 31 years and 58 NAION patients(71 affected eyes and 33 healthy eyes,25 females)with median age of 50 years were included.The CFF value either in healthy eyes or in affected eyes showed no statistical difference between the two groups(P>0.05).And when compared the CFF trichromatic value in affected eyes,the CFF value in the ON patients was lower than that in the NAION patients within 1-month onset(P<0.05),and higher than that in the NAION group within 3-6 months onset(P<0.05),whereas,no statistical differences were found at any other time points(P>0.05).When compared the affected eyes with monocular involvement within 1-month onset,both difference value and difference ratio of CFF in the ON group were greater than that of the NAION eyes(P<0.05).In eyes with severe visual impairment,the rCFF and gCFF of the NAION groups were lower than those of the ON eyes(P=0.037,0.049),and ROC analysis showed that the AUC of rCFF,gCFF and yCFF was 0.75,0.76,0.74,respectively,in discriminating ON and NAION eyes.Conclusion For patients with newly-onset or severe symptoms,CFF examination may be useful to distinguish ON from NAION.