脱髓鞘性视神经病变的临床特征

目的:回顾性分析脱髓鞘性视神经病变的临床特征。方法:收集我院特发性视神经炎(IDON)患者71例(IDON组)、视神经脊髓炎(NMO)患者69例(NMO组)、有视神经病变的多发性硬化(MS)患者64例(MS组)共204例患者的临床资料。结果:本组中有17例MS、26例NMO由IDON转化而来,但脱髓鞘性视神经病变也可发生在中枢神经系统脱髓鞘事件之后或者同时发生。NMO容易合并血清免疫学异常,MS容易累及双侧视神经且以球后视神经病变多见,IDON和NMO视功能障碍更为严重。随访生存分析表明,合并颅内病灶或血清免疫学异常的IDON患者转化为MS或NMO的风险明显高于其他正常患者。结论:脱髓鞘性视神经病变的诊断要严格遵循诊断流程,正确鉴别这3种疾病对制定治疗方案延缓疾病进展、降低致残率及判断预后具有重要意义。

前部缺血性视神经病变与大脑多发性缺血灶的临床分析

目的 回顾研究前部缺血性视神经病变（AION）与大脑多发性缺血灶的相关性。方法 选取2013年1月~2014年6月在我院住院治疗的38例AION患者为病例组;排除眼部疾患的40例正常人为对照组。均行颅脑磁共振成像（MRI）检查,分析AION与大脑多发性缺血灶之间的关系。结果 病例组38例患者中,27例颅脑MRI诊断为大脑多发性缺血灶,阳性率为71.05%（27/38）;正常对照组40例中,有12例颅脑MRI阳性,阳性率为30.00%（12/40）,两者差异有统计学意义（P〈0.05）。结论 大脑多发性缺血灶与AION关系密切,可为AION的病因及临床治疗提供有利线索。

性激素在视神经疾病中的研究进展

近年来,性激素在视神经疾病中所起的作用越来越受到关注。例如雌激素可减轻青光眼患者的视神经损伤并且有一定程度的降眼压作用,血清孕酮水平的降低与非动脉炎性前部缺血性视神经病变密切相关,男性相对更易患Leber遗传性视神经病变,以及多发硬化相关性视神经炎的复发率存在性别差异等,提示性激素在视神经疾病中扮演重要角色。该文就性激素在视神经疾病中的作用及其机制进行综述。

Microvascular blood flow velocities measured with a retinal function imager: inter-eye correlations in healthy controls and an exploration in multiple sclerosis

Background:The retinal microcirculation has been studied in various diseases including multiple sclerosis(MS).However,inter-eye correlations and potential differences of the retinal blood flow velocity(BFV)remain largely unstudied but may be important in guiding eye selection as well as the design and interpretation of studies assessing or utilizing retinal BFV.The primary aim of this study was to determine inter-eye correlations in BFVs in healthy controls(HCs).Since prior studies raise the possibility of reduced BFV in MS eyes,a secondary aim was to compare retinal BFVs between MS eyes,grouped based on optic neuritis(ON)history and HC eyes.Methods:Macular arteriole and venule BFVs were determined using a retinal function imager(RFI)in both eyes of 20 HCs.One eye from a total of 38 MS patients comprising 13 eyes with ON(MSON)and 25 eyes without ON(MSNON)history were similarly imaged with RFI.Results:OD(right)and OS(left)BFVs were not significantly different in arterioles(OD:3.95±0.59 mm/s;OS:4.08±0.60 mm/s,P=0.10)or venules(OD:3.11±0.46 mm/s;OS:3.23±0.52 mm/s,P=0.06)in HCs.Very strong inter-eye correlations were also found between arteriolar(r=0.84,P<0.001)and venular(r=0.87,P<0.001)BFVs in HCs.Arteriolar(3.48±0.88 mm/s)and venular(2.75±0.53 mm/s)BFVs in MSNON eyes were significantly lower than in HC eyes(P=0.009 and P=0.005,respectively).Similarly,arteriolar(3.59±0.69 mm/s)and venular(2.80±0.45 mm/s)BFVs in MSON eyes were also significantly lower than in HC eyes(P=0.046 and P=0.048,respectively).Arteriolar and venular BFVs in MSON and MSNON eyes did not differ from each other(P=0.42 and P=0.48,respectively).Conclusions:Inter-eye arteriolar and venular BFVs do not differ significantly in HCs and are strongly correlated.Our findings support prior observations that arteriolar and venular BFVs may be reduced in MS eyes.Moreover,this seems to be the case in both MS eyes with and without a history of ON,raising the possibility of global blood flow alterations in MS.Future larger studies are needed to assess differences in BFVs between MSON and MSNON eyes.

Emerging Applications of Optical Coherence Tomography Angiography (OCTA) in neurological research

Purpose:To review the clinical and research value of optical coherence tomography angiography(OCTA)in the field of neurology.Methods:Current literature involving OCTA were reviewed through PubMed using the search terms“optical coherence tomography angiography”,with“multiple sclerosis”,“Alzheimer’s disease”,“optic neuropathy”,or other closely-related terms.Results:OCTA has been applied in research to advance our understanding of the pathobiology of neurological disorders.OCTA-derived blood flow and vessel density measures are altered in multiple sclerosis(MS),Alzheimer’s disease(AD),and various optic neuropathies(ON)in varying regions of the posterior segment vasculature of the eye.These emerging research findings support the occurrence of retinal vascular alterations across a host of neurological disorders and raise the possibility that vasculopathy can be clinically relevant since it contributes to the pathobiology of several neurological disorders.Conclusion:OCTA may be beneficial for neurological research.Additional investigations using OCTA in neurological disorders will help to further validate its clinical and research utilities in terms of characterizing the role of vasculopathy in neurological disorders.

神经生长因子多药联合治疗缺血性视神经病变患者的临床疗效

目的:研究神经生长因子(NGF)多药联合治疗缺血性视神经病变(AION)患者的临床疗效。方法:选择2011年5月至2013年5月在我院接受治疗的AION患者100例(100只眼),根据数字表法随机分成观察组(50例,50只眼)及对照组(50例,50只眼)。对照组给予扩血管药和维生素神经营养性药物控制高血压或糖尿病等合并症,视情况给予糖皮质类激素治疗,观察组在此基础上另给予NGF药物治疗。对比两组疗效、对数视力、视野平均缺损值(MD)及视敏度通过图形视觉诱发电位(P-VEP100)P100波的潜伏期,观察两组不良反应。结果:观察组的总有效率为90.00%(45/50),显著高于对照组的74.00%(37/50),差异有统计学意义(P<0.05)。两组在治疗后的对数视力、视野MD以及P-VEP100均有改善,但观察组的改善幅度显著大于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论:NGF多药联合治疗AION患者疗效更佳,可促进患者视觉功能恢复,值得临床上推广使用。

视乳头血流与眼科疾病

视乳头的病理改变可能是由于视乳头血流异常引起，视乳头血流可通过激光多普勒血流仪（laser doppler flowmetry，LDF）及相干光断层扫描血管成像（optical coherence tomography angiography,OCTA）等观察，其在青光眼中会减少，所以探讨视乳头血流的变化有利于揭示青光眼的发病机制。此外，也有些研究发现视乳头血流与缺血性视神经病变、高度近视、视盘黑色素瘤、多发性硬化性视神经病变相关。