CAJ | 학술논문

目的了解前部缺血性视神经病变神经纤维束损害的后期动态变化及其对视功能的影响,确认实施神经保护治疗的临床意义.方法对临床诊断为前部缺血性视神经病变患者96例(128只眼),经急性期治疗病情基本稳定后转入随访观察,每3～6个月随诊一次,一年后每年随诊一次,每次作眼底、视力、视野及视盘周神经纤维层厚度OCT检查.对随诊检测数值进行统计分析并作比较性研究.结果 (1)全部病例均经6～12个月的随诊,达1～2年者72例,＞2～4年者47例,4年以上36例.(2)随诊期内原视神经萎缩及眼底情况无明显改变,有8例在之后另眼发生不同程度的前部缺血性视神经病变(8.7％).(3)随诊期内在排除屈光及其他因素外,视力变化差异无统计学意义.(4)随诊期内视野损害的形态位置无明显变化,而视野敏感度有所下降.(5)随诊期内初次视盘区OCT检查与以后各次相比视盘周神经纤维的厚度有不同程度的变薄.(6)随诊期内接受神经保护治疗者盘周神经纤维层的厚度及视野敏感度优于未接受治疗者.结论前部缺血性视神经病变后期神经纤维束仍处于缓慢受损状态,探讨受损机制,实施神经保护治疗的措施仍是必要的.
목적 료해전부결혈성시신경병변신경섬유속손해적후기동태변화급기대시공능적영향,학인실시신경보호치료적림상의의.방법 대림상진단위전부결혈성시신경병변환자96례(128지안),경급성기치료병정기본은정후전입수방관찰,매3～6개월수진일차,일년후매년수진일차,매차작안저、시력、시야급시반주신경섬유층후도OCT검사.대수진검측수치진행통계분석병작비교성연구.결과 (1)전부병례균경6～12개월적수진,체1～2년자72례,＞2～4년자47례,4년이상36례.(2)수진기내원시신경위축급안저정황무명현개변,유8례재지후령안발생불동정도적전부결혈성시신경병변(8.7％).(3)수진기내재배제굴광급기타인소외,시력변화차이무통계학의의.(4)수진기내시야손해적형태위치무명현변화,이시야민감도유소하강.(5)수진기내초차시반구OCT검사여이후각차상비시반주신경섬유적후도유불동정도적변박.(6)수진기내접수신경보호치료자반주신경섬유층적후도급시야민감도우우미접수치료자.결론 전부결혈성시신경병변후기신경섬유속잉처우완만수손상태,탐토수손궤제,실시신경보호치료적조시잉시필요적.
Objective To investigate the dynamics damage of the nerve fiber bundle and its effects on visual function in late phage of anterior ischemic optic neuropathy (AION),and confirm the clinical significance of taking further neuroprotective treatment.Methods Ninety-six patients (128 eyes)clinical diagnosed of anterior ischemic optic neuroipathy,through acute phage treatment and after becoming stable,were followed every 3-6 months and then every year one year later.For every followed time,the fundus,vision and visual field were examined and the thickness of nerve fiber layer was measured by OCT.The data were statistically analyzed and comparatively studied.Results (1) All patients were followed for 6～12 months,among them 72 cases were followed between 1 to 2 years,47 cases between 2 to 4 years,and 36 cases over 4 years.(2) There was no significant change of the optic atrophy and fundus during the followed time,8 cases (8.7％) developed anterior ischemic optic neuropathy in the fellow eye.(3) Exclude of the refraction and the other factors,there were no significant difference in visual acuity.(4) There was no significant change of the location and the form of visual field damage during the followed time,however the sensitivity decreased.(5) Compared to the first OCT inspection,the subsequent OCT inspection showed that the optic disc peripheral nerve fibers became thinner to different degree during the followed time.(6) During the followed time,the peripheral nerve fiber layer thickness and visual field sensitivity of the patients treated by the neuroprotective were better than those not treated.Conclusions In the late phage of NAION,the nerve fiber bundle are still damaged slowly.It is necessary to investigate the damage mechanism and take the neuroprotective treatment.