中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2010年
4期
314-318
,共5页
韩梅%陈松%王兰惠%解士勇%时冀川
韓梅%陳鬆%王蘭惠%解士勇%時冀川
한매%진송%왕란혜%해사용%시기천
视神经病变,缺血性/诊断%荧光素血管造影术/利用%体层摄影术,光学相干/利用%视野检查法/利用
視神經病變,缺血性/診斷%熒光素血管造影術/利用%體層攝影術,光學相榦/利用%視野檢查法/利用
시신경병변,결혈성/진단%형광소혈관조영술/이용%체층섭영술,광학상간/이용%시야검사법/이용
Optic neuropathy,ischemic/diagnosis%Fluorescein angiography/utilization%Tomography,optical coherence/utilization%Perimetry/utilization
目的 观察非动脉炎性前部缺血性视神经病变(NAION)患者的荧光素眼底血管造影(FFA)与光相干断层扫描(OCT)检查等影像特征.探讨其与视力、病程转归的关系.方法 回顾分析47例临床确诊的NAION患者47只眼的FFA、OCT检查资料.所有患者均接受视力、眼底、视野等常规眼科检查.初诊时同时进行FFA和OCT检查.FFA及视野检查按常规方法进行;OCT检查分别选择线性和环形扫描方式,进行黄斑和视盘的扫描.其中35例NAION患者分别于发病后0.5、1、2、3、6个月时进行OCT复查.回顾分析时,以36例患者的对侧健眼作为对照组,对比分析患眼FFA、视野、视盘OCT图像特征与视力、病程转归的相互关系.结果 FFA检查结果显示,所有患眼均表现为早期视盘充盈迟缓,晚期视盘呈强荧光渗漏,24只患眼在黄斑区出现强荧光渗漏.OCT检查结果显示,所有患眼视盘隆起,生理凹陷变窄或消失;视盘与黄斑(盘斑)之间神经上皮层组织增厚或神经上皮层隆起,下方有液性暗区.对照眼中,14只跟有正常视盘生理凹陷,22只眼无生理凹陷或较小的生理凹陷.NAION组0.5个月时黄斑中心凹处神经上皮层厚度、盘斑间神经上皮层最大厚度,视盘周围视网膜神经纤维层厚度均高于对照组,差异均有统计学意义(F＝6.51,26.12,75.49;P<0.05).2个月时盘斑间神经上皮层最大厚度、视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度较0.5个月时变薄.3个月时视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度较0.5个月时明显变薄,低于对照组,差异有统计学意义(F＝75.49,37.92;P<0.05).视野检查结果显示,下方视野缺损21例,占45.7%.OCT检查结果显示,随病程进展,视盘上方神经纤维层厚度下降的程度更明显,与视野的表现相一致.视力与黄斑中心凹处神经上皮层厚度、盘斑间神经上皮层最大厚度、视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度呈显著负相关关系(r=-0.394,-0.424,-0.412,-0.464;P<0.05).结论 NAION患者FFA特征为早期视盘充盈迟缓,晚期视盘呈强荧光渗漏;OCT特征为随病程发展,视网膜神经上皮层增厚,神经纤维层变薄.视盘形态及视网膜神经纤维层变化的OCT检查与视野检查结果一致;患者视力与神经上皮层厚度的OCT检查结果呈负相关关系.
目的 觀察非動脈炎性前部缺血性視神經病變(NAION)患者的熒光素眼底血管造影(FFA)與光相榦斷層掃描(OCT)檢查等影像特徵.探討其與視力、病程轉歸的關繫.方法 迴顧分析47例臨床確診的NAION患者47隻眼的FFA、OCT檢查資料.所有患者均接受視力、眼底、視野等常規眼科檢查.初診時同時進行FFA和OCT檢查.FFA及視野檢查按常規方法進行;OCT檢查分彆選擇線性和環形掃描方式,進行黃斑和視盤的掃描.其中35例NAION患者分彆于髮病後0.5、1、2、3、6箇月時進行OCT複查.迴顧分析時,以36例患者的對側健眼作為對照組,對比分析患眼FFA、視野、視盤OCT圖像特徵與視力、病程轉歸的相互關繫.結果 FFA檢查結果顯示,所有患眼均錶現為早期視盤充盈遲緩,晚期視盤呈彊熒光滲漏,24隻患眼在黃斑區齣現彊熒光滲漏.OCT檢查結果顯示,所有患眼視盤隆起,生理凹陷變窄或消失;視盤與黃斑(盤斑)之間神經上皮層組織增厚或神經上皮層隆起,下方有液性暗區.對照眼中,14隻跟有正常視盤生理凹陷,22隻眼無生理凹陷或較小的生理凹陷.NAION組0.5箇月時黃斑中心凹處神經上皮層厚度、盤斑間神經上皮層最大厚度,視盤週圍視網膜神經纖維層厚度均高于對照組,差異均有統計學意義(F＝6.51,26.12,75.49;P<0.05).2箇月時盤斑間神經上皮層最大厚度、視網膜神經纖維層平均厚度、視盤顳側視網膜神經纖維層厚度較0.5箇月時變薄.3箇月時視網膜神經纖維層平均厚度、視盤顳側視網膜神經纖維層厚度較0.5箇月時明顯變薄,低于對照組,差異有統計學意義(F＝75.49,37.92;P<0.05).視野檢查結果顯示,下方視野缺損21例,佔45.7%.OCT檢查結果顯示,隨病程進展,視盤上方神經纖維層厚度下降的程度更明顯,與視野的錶現相一緻.視力與黃斑中心凹處神經上皮層厚度、盤斑間神經上皮層最大厚度、視網膜神經纖維層平均厚度、視盤顳側視網膜神經纖維層厚度呈顯著負相關關繫(r=-0.394,-0.424,-0.412,-0.464;P<0.05).結論 NAION患者FFA特徵為早期視盤充盈遲緩,晚期視盤呈彊熒光滲漏;OCT特徵為隨病程髮展,視網膜神經上皮層增厚,神經纖維層變薄.視盤形態及視網膜神經纖維層變化的OCT檢查與視野檢查結果一緻;患者視力與神經上皮層厚度的OCT檢查結果呈負相關關繫.
목적 관찰비동맥염성전부결혈성시신경병변(NAION)환자적형광소안저혈관조영(FFA)여광상간단층소묘(OCT)검사등영상특정.탐토기여시력、병정전귀적관계.방법 회고분석47례림상학진적NAION환자47지안적FFA、OCT검사자료.소유환자균접수시력、안저、시야등상규안과검사.초진시동시진행FFA화OCT검사.FFA급시야검사안상규방법진행;OCT검사분별선택선성화배형소묘방식,진행황반화시반적소묘.기중35례NAION환자분별우발병후0.5、1、2、3、6개월시진행OCT복사.회고분석시,이36례환자적대측건안작위대조조,대비분석환안FFA、시야、시반OCT도상특정여시력、병정전귀적상호관계.결과 FFA검사결과현시,소유환안균표현위조기시반충영지완,만기시반정강형광삼루,24지환안재황반구출현강형광삼루.OCT검사결과현시,소유환안시반륭기,생리요함변착혹소실;시반여황반(반반)지간신경상피층조직증후혹신경상피층륭기,하방유액성암구.대조안중,14지근유정상시반생리요함,22지안무생리요함혹교소적생리요함.NAION조0.5개월시황반중심요처신경상피층후도、반반간신경상피층최대후도,시반주위시망막신경섬유층후도균고우대조조,차이균유통계학의의(F＝6.51,26.12,75.49;P<0.05).2개월시반반간신경상피층최대후도、시망막신경섬유층평균후도、시반섭측시망막신경섬유층후도교0.5개월시변박.3개월시시망막신경섬유층평균후도、시반섭측시망막신경섬유층후도교0.5개월시명현변박,저우대조조,차이유통계학의의(F＝75.49,37.92;P<0.05).시야검사결과현시,하방시야결손21례,점45.7%.OCT검사결과현시,수병정진전,시반상방신경섬유층후도하강적정도경명현,여시야적표현상일치.시력여황반중심요처신경상피층후도、반반간신경상피층최대후도、시망막신경섬유층평균후도、시반섭측시망막신경섬유층후도정현저부상관관계(r=-0.394,-0.424,-0.412,-0.464;P<0.05).결론 NAION환자FFA특정위조기시반충영지완,만기시반정강형광삼루;OCT특정위수병정발전,시망막신경상피층증후,신경섬유층변박.시반형태급시망막신경섬유층변화적OCT검사여시야검사결과일치;환자시력여신경상피층후도적OCT검사결과정부상관관계.
Objective To observe the characteristics of fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) in nonarteritic anterior ischemic optic neuropathy (NAION),and investigate its relation with visual acuity and course of disease. Methods The clinical data of 47 patients (47 eyes) with NAION were retrospectively analyzed. All the patiens had undergone visual acuity, fundus and visual field examination ,meanwhile FFA and OCT were carried out at first visit. FFA and visual field were carried out by routine. OCT was carried out by line and circle shape scanning in macula and optic disc.Thirty-five NAION patients were checked with OCT at half, one, two, three and six month after onset in respectively. Take the healthy fellow eyes of 36 NAION patiens as control group. The FFA, visual field, OCT characteristics and relation with visual acuity and course disease were comparatively analyzed. Results FFA showed that all the eyes appear as delayed filling of the optic disc in early stage and hyperfluorescence leakage of the optic disc in late stage,besides hyperfluorescence presented to macular area in 24 eyes. OCT showed that optic papilla swelling and physiological depression narrow or nearly disappearance, neuroepithelial layer thickening or neuroepithelial layer eminence and subretinal fluidity area opaca between optic disc and macula. There were 14 eyes with normal physiological depression and 22 eyes with small physiological depression or non- physiological depression in control group. Half month after onset, the neuroepithelial layer thickness of macula fovea, the maximum thickness of neuroepithelial layer between optic disc and macula, and the average retinal nerve fiber layer ( RNFL) thickness in NAION group were higher than those in the control group,the difference were statistically significant (F=6. 51,26. 12,75. 49; P<0. 05). Two months after onset,the maximum thickness of neuroepithelial layer between optic disc and macula, the average RNFL thickness, and the RNFL thickness of temporal optic disc in NAION group were significant thinner, but the elevated height of the optic disc in NAION group were near those of the control group. Three months after onset, the average RNFL thickness and the RNFL thickness of temporal optic disc in NAION group decreased continually, they were lower than those of the control group, the difference were statistically significan(F=75. 49,37. 92;P<0. 05). Visual field showed that inferior defect were found in 21 eyes (45%). With progress, the superior RNFL thickness obviously decreased, coincidence with appearance of visual field. It indicate that the superior optic atrophy serious. Visual acuity had significant negative correlation with the neuroepithelial layer thickness of macula fovea, the neuroepithelial layer maximum thickness between optic disc and macula, the average RNFL thickness, the RNFL thickness of temporal optic disc(r=-0.394,-0. 424,-0. 412,-0. 464; P<0. 05). Conclusions FFA showes that hyperfluorescence leakage appearanced in part macula. OCT showes that RNFL becomes thinner as the disease duration increases. The results of OCT and visual field examinaion in the configuration of optic disc and changes of RNFL are accordant.
