Mesenchymal stem cell therapy in retinal and optic nerve diseases: An update of clinical trials

Retinal and optic nerve diseases are degenerative ocular pathologies which lead to irreversible visual loss. Since the advanced therapies availability, cell-based therapies offer a new all-encompassing approach. Advances in the knowledge of neuroprotection, immunomodulation and regenerative properties of mesenchymal stem cells(MSCs) have been obtained by several preclinical studies of various neurodegenerative diseases. It has provided the opportunity to perform the translation of this knowledge to prospective treatment approaches for clinical practice. Since 2008, several first steps projecting new treatment approaches, have been taken regarding the use of cell therapy in patients with neurodegenerative pathologies of optic nerve and retina. Most of the clinical trials using MSCs are in Ⅰ/Ⅱ phase, recruiting patients or ongoing, and they have as main objective the safety assessment of MSCs using various routes of administration. However, it is important to recognize that, there is still a long way to go to reach clinical trials phase Ⅲ-Ⅳ. Hence, it is necessary to continue preclinical and clinical studies to improve this new therapeutic tool. This paper reviews the latest progress of MSCs in human clinical trials for retinal and optic nerve diseases.

Quantitative study of peripapillary retinal nerve fiber layer thickness and peripapillary vessel density in patients with different stages of Parkinson's disease

AIM: To observe the changes in the thickness of peripapillary retinal nerve fiber layer(p RNFL) and peripapillary vessel density(pVD) in patients with different stages of Parkinson's disease(PD).METHODS: Totally 47 patients(47 eyes) with primary PD were divided into the mild group and the moderateto-severe group according to Hoehn & Yahr(H&Y) stage. Among them, there were 27 cases(27 eyes) in mild group and 20 cases(20 eyes) in moderate-to-severe group. And 20 cases(20 eyes) who were included in the control group were healthy people who came to our hospital for health screening at the same time. All participants underwent optical coherence tomography angiography(OCTA) examinations. The pRNFL thickness, total vessel density(tVD) and capillary vessel density(cVD) of the optic disc in average, superior half, inferior half, superior nasal(SN), nasal superior(NS), nasal inferior(NI), inferior nasal(IN), inferior temporal(IT), temporal inferior(TI), temporal superior(TS), and superior temporal(ST) were measured. One-way ANOVA was used to compare the differences of optic disc parameters among the three groups, and Pearson and Spearman correlations were used to analyze the correlation between pRNFL, pVD and the disease duration, H&Y stage and UPDRS-Ⅲ score in patients with PD, respectively.RESULTS: There were significant differences in p RNFL thickness in average, superior half, inferior half, SN, NS, IN, IT and ST quadrants among the three groups(P<0.05). In PD group, the pRNFL thickness in average, superior half, inferior half, NS and IT quadrants were negatively correlated with H&Y stage and UPDRS-Ⅲ score, respectively(P<0.05). There were statistically significant differences in the cVD of whole image, inferior half, NI and TS quadrants, the tVD of the whole image, inferior half, and peripapillary among the three groups(P<0.05). In PD group, the tVD of whole image and the c VD of NI and TS quadrants were negatively correlated with the H&Y stage, respectively(P<0.05);the cVD of TS quadrant was negatively correlated with UPDRS-Ⅲ score(P<0.05).CONCLUSION: The thickness of pRNFL in PD patients is significantly decreased, and it is negatively correlated with H&Y stage and UPDRS-Ⅲ score. With the increase of the severity of the disease, the pVD parameters in PD patients increase at first in the mild group, and then decrease in the moderate-to-severe group, and negatively correlate with H&Y stage and UPDRS-Ⅲ score.

Optical coherence tomography assessed retinal nerve fiber layer thickness in patients with Alzheimer's disease:a meta-analysis

AIM:To investigate the difference of retinal nerve fiber layer(RNFL) thickness between Alzheimer's disease patients and normal people,so as to provide clue for the early diagnosis of Alzheimer's disease.· METHODS:The articles on the association of RNFL thickness and Alzheimer's disease were retrieved by searching international and national databases.The qualified articles were assessed by meta analysis with Stata11.0 software.The results were pooled using weighted mean difference(WMD) with a corresponding 95% confidence interval(CI).· RESULTS:Totally 7 studies enrolled 324 eyes were included in the meta-analysis.The results of meta analysis showed that in AD patients,there was a significant average RNFL thickness reduction compared with the control group [WMD=-17.561,95%CI:(-23.971,-11.151)].There were significant differences in superior,inferior,nasal and temporal RNFL thickness between the two groups.WMD with a 95%CI were [-18.829,95%CI:(-25.915,-11.743);P<0.05],[-25.775,95%CI:(-34.304,-17.247);P <0.05],[-16.877,95%CI:(-29.141,-4.613);P<0.001] and [-14.565,95%CI:(-28.002,-1.128);P<0.001] respectively.Begg's test and Egger's test did not show significant difference,funnel plot was basically symmetrical,indicating that there was no publication bias existed.· CONCLUSION:There are significant differences in the RNFL thickness in all quadrants between the two groups.RNFL thickness is reduced in AD patients compared with the control group.·

Retinal thickness and vascular parameters using optical coherence tomography in Alzheimer's disease:a meta-analysis

Examining the retinal tissue has the potential to provide a unique method and technique to quantify Alzheimer’s disease-related changes in participants at various stages of the disease.In this metaanalysis,we aimed to investigate the association of various optical coherence tomography parameters with Alzheimer’s disease and whether retinal measurements can be used to diffe rentiate between Alzheimer’s disease and control subjects.Scientific databases including Google Schola r,Web of Science,and PubMed were systematically searched for published articles that evaluated retinal nerve fiber layer thickness and retinal microvascular network in Alzheimer’s disease and control subjects.Seventy-three studies(5850 participants,including 2249 Alzheimer’s disease patients and 3601controls) were included in this meta-analysis.Relative to controls,Alzheimer’s disease patients had a significantly lower global retinal nerve fiber layer thickness(standardized mean difference [SMD]=-0.79,95% confidence intervals [CI]:-1.03 to-0.54,P <0.00001) as well as each quadrant being thinner in Alzheimer’s disease versus controls.Regarding macular paramete rs,values measured by optical coherence tomography were significantly lower in Alzheimer’s disease than controls for macular thickness(pooled SMD:-0.44,95% CI:-0.67 to-0.20,P=0.0003),foveal thickness(pooled SMD=-0.39,95% CI:-0.58 to-0.19,P <0.0001),ganglion cell inner plexiform layer(SMD=-1.26,95% CI:-2.24 to-0.27,P=0.01) and macular volume(pooled SMD=-0.41,95% CI-0.76 to-0.07,P=0.02).Analysis using optical coherence tomography angiography parameters revealed mixed results between Alzheimer’s disease and controls.Superficial vessel density(pooled SMD=-0.42,95% CI:-0.68 to-0.17,P=0.0001) and deep vessel density(pooled SMD=-0.46,95% CI:-0.75 to-0.18,P=0.001) were found to be thinner in Alzheimer’s disease patients whereas the foveal avascular zone(SMD=0.84,95% CI:0.17-1.51,P=0.01) was larger in controls.Vascular density and thickness of various retinal laye rs were decreased in Alzheimer’s disease patients compared to controls.Our results provide evidence for optical coherence tomography technology having the potential to detect retinal and microvascular changes in patients diagnosed with Alzheimer’s disease and aid in monito ring and early diagnosis methods.

Establishing a cat model of chronic optic nerve compression injury

BACKGROUND： An animal model of chronic optic nerve injury is necessary to further understand the pathological mechanisms involved. OBJECTIVE： To establish a stabilized, chronic, optic nerve crush model, which is similar to the clinical situation to explore histopathological and optic electrophysiological changes involved in this injury. DESIGN, TIME AND SETTING： A randomized and controlled animal trial was performed at Shanghai Institute of Neurosurgery from May to October 2004, MATERIALS： A BAL3XRAY undetachable balloon and Magic-BD catheter were provided by BLAT, France; JX-2000 biological signal processing system by Second Military Medical University of Chinese PLA, China; inverted phase contrast microscopy by Olympus, Japan. METHODS： A total of twenty normal adult cats were randomly assigned to control （n = 5） and model （n = 15） groups, according to different doses of contrast agent injected through balloons as follows： 0.2 mL injection, 0.25 mL injection, and 0.35 mL injection, with each group containing 5 animals. Imitating the clinical pterion approach, the optic nerves were exposed using micro-surgical methods. An engorged undetachable balloon was implanted beneath the nerve and connected to a catheter. Balloon size was controlled with a contrast agent injection （0.1 mL/10 min） to form an occupying lesion model similar to sellar tumors. MAIN OUTCOME MEASURES： The visually evoked potential examination was used to study optical electrophysiology changes in pre-post chronic optical nerve injury. Ultrastructural pathological changes to the optic nerve were analyzed by electron microscopy. RESULTS： During the early period （day 11 after modeling）, visually evoked potential demonstrated no significant changes. In the late period （day 51 after modeling）, recorded VEP demonstrated that P1 wave latency was prolonged and P1 wave amplitude was obviously reduced. Following injury, the endoneurium, myelin sheath, lamella, axolemma, and axon appeared disordered. CONCLUSION： Results demonstrated that the chronic, intracranial, optical nerve crush model was stable and could simulate optic nerve lesions induced by sellar tumors. Under the condition of chronic optical nerve crush, visually evoked potentials were aggravated.

The Retinal Nerve Fiber Layer Defects in Patients with Anterior Ischemic Optic Neuropathy

Purpose:To demonstrate the effects of optic nerve ischemia on retinal nerve fiber layer(RNFL)and the associated visual dysfunction.Methods:23patients(25eyes)wits anterior ischemic optic neuropathy(AION)un derwent fundus fluorescein angiography(FFA),and then red-foree light pic-tures were taken via SE-40exceiter filter.All pictures were printed for RNAFL analysis,Humphrey central field analysis was conducted.All dataobtained fromFFA and visual field defects were analysed statistically.Results:The RNFL defects and the corresponding visual field edfects were pre-sented in 23of 25eyes(92%),The optic disc filling defects,RNAL edfects and visual field defects were found to be highly correspondent to each other.The RNFL defects were mainly the local losses of RNFL which were correspondent to the ischemic regions.Conclusion:The poor optic disc filling or ischemia can result in the RNFL defects which cause the associated visual dysfunction.Because RNFLdefects are irrever-siable changes,the potential values in predicting the prognosis of visual field de-fects caused by RNFL damages were suggested.Eye Science1995;11:165-167.

促红细胞生成素在常见视神经和视网膜疾病保护及修复中的研究进展

促红细胞生成素(EPO)和EPO受体不仅存在于造血组织中,在造血外组织中也广泛存在。组织缺血、缺氧以及炎症因子水平升高均可促进EPO表达,并通过抗凋亡、抗炎、抗氧化、抗神经毒性、促进神经再生等一系列复杂机制在中枢神经系统中发挥保护作用,促进神经修复。视神经和视网膜是中枢神经系统的延伸,许多视神经和视网膜疾病本质也由缺血、缺氧所致,因此EPO在视神经和视网膜疾病中也发挥重要作用。深入研究EPO在视神经和视网膜疾病中的保护作用,可以为相关疾病的治疗提供新思路。

视网膜激光光凝术治疗眼底病的临床效果

目的:分析视网膜激光光凝术治疗眼底病的临床效果。方法:选取2022年2月—2023年2月平原县第一人民医院眼科收治的60例眼底病患者作为研究对象,以双盲法分为对照组与试验组,各30例。对照组采用常规药物治疗,试验组实施视网膜激光光凝术治疗。比较两组生活质量、视神经功能、视力改善情况、治疗效果。结果:治疗前,两组物质、躯体、社会、心理、精神评分比较,差异无统计学意义(P>0.05);治疗后,两组物质、躯体、社会、心理、精神评分高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。治疗前,两组视野平均光敏度、视网膜神经纤维厚度、视野平均缺损比较,差异无统计学意义(P>0.05);治疗后,两组视野平均光敏度、视网膜神经纤维厚度大于治疗前,且观察组大于对照组,两组视野平均缺损小于治疗前,且观察组小于对照组,差异有统计学意义(P<0.05)。试验组视力改善情况优于对照组,差异有统计学意义(P<0.05)。试验组治疗总有效率高于对照组,差异有统计学意义(P=0.044)。结论:视网膜激光光凝术治疗眼底病的临床效果显著,可改善患者视神经功能,提高视力与生活质量。

Stem Cell Ophthalmology Treatment Study (SCOTS)： bone marrow-derived stem cells in the treatment of Leber＇s hereditary optic neuropathy

The Stem Cell Ophthalmology Treatment Study （SCOTS） is currently the largest-scale stem cell ophthal- mology trial registered at ClinicalTrials.gov （identifier： NCT01920867）. SCOTS utilizes autologous bone marrow-derived stem cells （BMSCs） to treat optic nerve and retinal diseases. Treatment approaches include a combination of retrobulbar, subtenon, intravitreal, intra-optic nerve, subretinal, and intravenous injection of autologous BMSCs according to the nature of the disease, the degree of visual loss, and any risk factors related to the treatments. Patients with Leber＇s hereditary optic neuropathy had visual acuity gains on the Early Treatment Diabetic Retinopathy Study （ETDRS） of up to 35 letters and Snellen acuity improvements from hand motion to 20/200 and from counting fingers to 20/100. Visual field improvements were noted. Macular and optic nerve head nerve fiber layer typically thickened. No serious complications were seen. The increases in visual acuity obtained in our study were encouraging and suggest that the use of autolo- gous BMSCs as provided in SCOTS for ophthalmologic mitochondrial diseases including Leber＇s hereditary optic neuropathy may be a viable treatment option.

Potential role of retina as a biomarker for progression of Parkinson's disease

Optical coherence tomography (OCT) noninvasively quantifies the thickness of the retinal nerve fiber layer (RNFL). OCT has been studied in several neuro-ophthalmic conditions, including Parkinson’s disease (PD). Recent studies suggest that the quantitative analysis of RNFL can be precisely and noninvasively done by OCT scans and the results suggest that the thickness of RNFL is significantly decreased in patients with PD compared with age-matched controls and the foveal retinal thickness correlates with disease severity in PD. In this article, the application of OCT imaging of the retina in PD was reviewed. Literature survey of PubMed was carried out using the search terms of "Optical Coherence Tomography" combined with "Parkinson’s Disease" and "retinal nerve fiber layer" (without restriction to the year of publication). Some related articles were also included. The search was completed in Jul. 2011 and revised and updated as necessary. The aim of this article is to review the current literatures on the use of optical coherence tomography in patients affected by PD and to enhance its use in clinical practice in neuro-ophthalmology.

Optic Neuritis: Hidden Manifestations and Mimickers

Optic neuritis is the most common cause of unilateral visual loss associated with orbital pain on ocular movements and impaired colour vision. It can present with anterior optic neuritis, papillitis, a swollen optic disc, retrobulbar neuritis with a normal optic disc, neuritis with oedema of the optic disc and the macular star or anterior ischemic neuropathy. It may be the only manifestation of a disease such as demyelination or associated with systemic diseases such as systemic lupus, giant cell arteritis, Sjogren’s syndrome, herpes simplex, herpes zoster, Lyme disease, CMV, EBV, HIV, toxoplasmosis, West Nile virus, Chikungunya, dengue fever, Rift Valley fever, mumps, rubella, measles, cat scratch disease, tuberculosis, syphilis, rickettsia illnesses, Q fever, Whipple disease, brucellosis, leptospirosis, leprosy, toxocariasis, malaria, Cryptococcus, candidiasis, histoplasmosis, Aspergillosis, mucormycosis, Bacillus Chalmette-Guerin (BCG) vaccination, ethanol and methanol toxicity, sarcoidosis, neuromyelitis optica and Liber’s hereditary optic neuropathy. A systemic approach to the diagnosis is of paramount importance in confirming, diagnosing and treating optic neuritis and underlying systemic diseases to provide definitive cures. Failure to diagnose optic neuritis and treat the cause may result in optic atrophy and permanent blindness. In this paper, we reviewed the diagnosis and differential diagnoses of optic neuritis, including arteritis, ischemic, neuroretina, and vasculitic causes.

神经重症患者术后视神经鞘直径与有创颅内压相关性研究

目的:依靠超声测量视神经鞘直径(optic nerve sheath diameter,ONSD)在神经重症患者术后建立有效预测颅内压(intracranial pressure,ICP)的方法。方法:连续监测52例神经重症患者术后有创ICP,使用经眼眶超声测量视神经鞘在垂直和水平方向上直径的平均值,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析ONSD诊断颅内高压的效能,并评估该方法的灵敏度和特异度。结果:所有患者的双眼平均ONSD[(5.27±0.47)mm]和有创ICP[(11.77±6.18)mmHg]相关性良好(r=0.79,P<0.01)。ROC曲线得到ONSD诊断颅内高压(ICP≥20 mmHg)的最佳临界值为5.625 mm,诊断的灵敏度为74.3%,特异度为90.4%。同时获得ICP为5、10、15、25 mmHg对应的ONSD临界值为5.175、5.325、5.375、5.825 mm。结论:床旁超声经眼眶测量ONSD可以判断ICP变化,尤其在神经重症患者有创ICP或影像学检查受限的情况下,可以动态、快捷、无创地评估ICP,具有显著的临床应用价值,值得推广。

新中国成立后中医神经眼科学的发展历程

中医学对目系疾病诊治历史悠久,最早可见于《黄帝内经》,历代医家又在其基础上进行了进一步阐释,其归属于现代医学神经眼科范畴。新中国成立以后,伴随西医神经眼科的快速发展,中医学在神经眼科疾病的发病机制、诊断治疗等方面也取得了巨大飞跃。本文总结归纳新中国成立后中医神经眼科学的历史源流、发展和成就,旨在让更多中、西医眼科同行了解中医神经眼科学的发展。

临界闪烁融合频率在视网膜和视神经疾病中的应用

作为一种新型无创且操作简单的主观检查手段,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。作为早期识别脱髓鞘病变和评估视功能恢复情况的敏感指标,上个世纪已被国外学者用于视网膜和视神经疾病研究中,包括氯喹中毒性视网膜病变、糖尿病视网膜病变、中心性浆液性视网膜病变、年龄相关的黄斑病变、乙胺丁醇中毒性视神经病变、视神经炎和非动脉炎性前部缺血性视神经病变。在视网膜和视神经疾病中,CFF均有不同程度下降,依据CFF改善程度以及主要损害的色光可能有助于视网膜和视神经疾病的鉴别,且CFF与其他视功能,视力、视野、视觉诱发电位的潜时具有较好的相关性。目前国内相关研究尚处于起步阶段,本文就CFF在视网膜和视神经疾病的应用情况做一总结。

近期皮质下小梗死患者视神经组织厚度与血管周围间隙扩大的相关性研究

目的探讨近期皮质下小梗死(RSSI)患者视神经组织厚度与血管周围间隙扩大(EPVS)之间的关系。方法选取2021年11月至2022年12月南京医科大学附属常州市第二人民医院收治的RSSI患者72例。所有患者行头颅MRI、光学相干断层成像(OCT)及眼底照相检查,用软件半自动分割并测量视网膜神经纤维层(RNFL)及神经节细胞内丛状层复合体(GCL-IPL)厚度,通过眼底照相观察眼底出血、渗出等眼底病变情况。用视觉量化评估法对EPVS程度进行分级,根据分级将所有患者分为EPVS无-轻度组32例和EPVS中重度组40例,进一步对基底节区EPVS(BG-EPVS)及半卵圆中心EPVS(CSO-EPVS)进行分级并分为BG-EPVS无-轻度组31例和BG-EPVS中重度组41例,CSO-EPVS无-轻度组39例和CSO-EPVS中重度组33例,分别比较各组临床资料。结果EPVS无-轻度组与EPVS中重度组年龄、高血压、RNFL及GCL-IPL厚度比较有显著差异(P<0.05,P<0.01)。BG-EPVS无-轻度组与BG-EPVS中重度组年龄、高血压、RNFL及GCL-IPL厚度比较有显著差异(P<0.01)。多因素logistic回归分析显示,年龄(OR=1.207,95%CI:1.028~1.416,P=0.021)、高血压(OR=7.264,95%CI:1.079~11.929,P=0.042)、RNFL厚度(OR=0.753,95%CI:0.617~0.915,P=0.004)、GCL-IPL厚度(OR=0.848,95%CI:0.758~0.949,P=0.004)是BG-EPVS等级的独立相关因素。Spearman相关分析显示,RNFL及GCL-IPL厚度与BG-EPVS等级呈负相关(r=-0.571、r=-0.649,P<0.01)。结论RNFL与GCL-IPL厚度是BG-EPVS等级的独立相关因素,与BG-EPVS等级呈负相关,OCT对评估RSSI患者EPVS病变程度有临床价值。

视网膜神经纤维层的定量评估在视网膜疾病中的应用

视网膜神经纤维层是视网膜的最内层,主要由来自视网膜神经节细胞的无髓鞘轴突组成,此外还有神经胶质细胞与视网膜血管,其厚度与年龄、眼球增长、眼底结构改变等因素相关。光学相干断层扫描可以清晰展示角膜、视网膜、脉络膜、视神经等高分辨率断层图像,可以在活体上显示生物学组织的细微结构,在临床与科研中已获得广泛应用。在青光眼视神经病变中,光学相干断层扫描可以发现视野异常前的视网膜神经纤维层损害,已成为青光眼早期诊断与视神经损伤程度检测的重要手段。除视神经病外,越来越多的研究表明许多视网膜血管疾病、神经元变性疾病等视网膜疾病也有视网膜神经纤维层的损伤。探讨视网膜疾病与神经纤维层的关系,将有利于进一步推进对视网膜疾病发病机制及病理改变的认识。本文就视网膜神经纤维层的定量评估与多种视网膜疾病的关系展开综述,为其在视网膜疾病中的应用提供参考。

OCT观察帕金森病患者视网膜形态变化的Meta分析

目的采用Meta分析探究光学相干断层扫描(OCT)观察帕金森病(PD)患者视网膜形态变化的价值。方法检索2017年1月—2022年1月PubMed、Embase、The Cochrane Library、万方、中国知网数据库关于OCT观察PD患者视网膜形态变化的临床研究,视网膜神经纤维层(RNFL)厚度、神经节细胞层(GCL)厚度、视盘面积、视杯面积、黄斑厚度为主要结局指标,使用RevMan 5.3软件进行Meta分析。结果共纳入26篇文献,共计1,795例患者(2,790只眼),其中PD组873例(1,343只眼),对照组922例(1,447只眼)。与对照组比较,PD组患者RNFL厚度降低[SMD=-0.550,95%CI(-0.730,-0.360),Z=5.840,P=0.000],GCL厚度降低[SMD=-0.430,95%CI(-0.680,-0.180),Z=3.370,P=0.001],黄斑厚度降低[SMD=0.220,95%CI(-0.330,-0.100),Z=3.780,P=0.000],差异均有统计学意义;但PD组患者视盘面积、视杯面积较对照组差异无统计学意义(均P>0.05)。结论PD患者RNFL、GCL、黄斑区厚度均低于正常人群,OCT可以辅助早期诊断PD。

雷公藤红素治疗眼科疾病的作用机制研究进展

雷公藤红素是中药雷公藤的活性成分之一,随着研究的深入,其被证实在一些眼病中具有治疗作用。为了完善雷公藤红素的合理应用,本文综述了其治疗眼病的作用机制,总结相关分子机制和信号通路,发现雷公藤红素可以通过抗炎、抗新生血管形成、免疫调节、保护神经细胞等方式干预角膜炎、黄斑变性、视神经疾病、白内障等眼病,但雷公藤红素的毒副作用限制了其在临床上的应用。本文可为探索未来雷公藤红素的研究方向提供参考。

CHANGES OF THE THICKNESS OF RETINA NERVE FIBER LAYER IN ALZHEIMER'S DISEASE

Objective To determine the changes of retina nerve fiber thickness with optical coherence tomography(OCT) in Alzheimer’s disease(AD) patients.Methods OCT was used to measure the thickness of retinal nerve fiber layer(RNFL) from 38 AD patients and 26 healthy age-matched controls.The corrected visual acuity and intraocular pressure were measured and the dilated fundus examinations were also performed in those subjects.Results Compared with healthy age-matched controls,the RNFL thickness of AD patients(95.40±29.45) were much thinner than the controls(105.91±29.87)(P <().05),especially in superior quadrant,while no difference was found in the other retinal area.Conclusion Retinal nerve degeneration may be present in the retina of AD patients and this degeneration is likely localized preferentially to the superior quadrant.

经鼻内窥镜视神经管减压术的初步报告

目的探索治疗视神经外伤较好的手术方法。方法开展了经鼻内窥镜视神经管减压术，并与鼻外进路进行比较。结果采用经鼻内窥镜鼻内进路视神经管减压术１４例，其中９例视力分别从术前的无光感、眼前手动、５０ｃｍ指数、眼前手动、无光感、光感、无光感、眼前手动、无光感到术后的０．２、０．３、０．３＋２、０．４、０．０６、０．３、０．１、０．７、０．１２，３例眼球活动障碍恢复正常，随访时间１个月～１年。讨论了经鼻内窥镜视神经管减压术的手术解剖学，术中注意事项，手术进路的优点和不足。结论认为经鼻内窥镜筛蝶窦进路视神经管减压术术中出血少，手术时间明显缩短，具有更大的实用性，是治疗外伤性视神经外伤的较好手术方法。