鼻咽癌放疗后并发视神经视网膜病变的临床研究

Clinical study on optic neuropathy and retinopathy subsequent to radiotherapy of nasopharyngeal carcinoma

目的 探讨鼻咽癌放疗后并发视神经视网膜病变患者的临床特征。方法 对 34例 (68只眼 )鼻咽癌放疗后出现视功能障碍及眼底病变的患者进行视力、眼底、荧光眼底血管造影 (FFA)及视野检查。结果 眼底病变分视乳头型和视网膜型。视乳头型以视乳头水肿或苍白萎缩为主 ;视网膜型以视网膜棉绒样斑、出血、血管异常或黄斑病变为主。 34例患者中 ,65 7% (2 2 34)在放疗后 3年内出现视功能障碍及眼底病变。FFA检查 :88 1 % (59 67)的患眼视乳头有缺血影像 ,65 7% (44 67)的患眼黄斑拱环缺损 ,79 1 % (53 67)的患眼有微动脉瘤 ,53 7% (36 67)的患眼出现视网膜内毛细血管无灌注区等微循环障碍的表现 ,视野检查伴有象限缺损和不规则暗点。结论 鼻咽癌放疗后 ,首发病变为毛细血管闭塞及微循环障碍 ,继而小动、静脉闭塞或静脉阻塞 ,从而导致视乳头、黄斑及视网膜慢性缺血缺氧。视神经萎缩。

Objective To explore the characteristics of optic neuropathy and retinopathy subsequent to radiotherapy of nasopharyngeal carcinoma (NPC) Methods Sixty eight eyes from 34 patients with fundus disease and visual disturbance after NPC radiotherapy were studied by vision testing, fundus examination, fundus fluorescein angiography (FFA) and computer analysis of visual field Results There were two types of fundus diseases: optic neuropathy and retinopathy The former mainly showed edema, pale and atrophy of the optic disc The latter showed mainly cotton wool spots, bleeding, abnormal vessels or maculopathy of the retina In 65 7% (22/34) of the patients fundus disease and visual disturbance occurred within 3 years after radiotherapy FFA revealed that 88 1% (59/67) of the cases showed intense fluorescence, 65 7% of the cases (44/67) showed extensive flaw on macula, 71 9% of the cases (53/67) showed microaneurysm, and 53 7% of the cases (36/67) showed lack of perfusion of the retinal capillary network Visual field test showed quadrant defect and irregular scotoma Conclusions Early damage of the fundus subsequent to radiotherapy of NPC is the occlusion of capillary vessels or microcirculation, followed by occlusion of the small artery or vein, which causes chronic anoxemia on the optic disk, the macula, and the retina The atrophy of the optic nerve, ischemic maculopathy, and retinal neo vascular membrane may cause hemorrhage in the vitreous and retinal detachment, which can result in blindness These changes are similar to the changes of ischemic optic neuropathy and diabetic retinopathy, which might offer a clue about the prevention and treatment of fundus damage subsequent to radiotherapy of NPC