CAJ | 학술논문

目的探讨纤维发育不良导致视神经管狭窄时视神经头部的改变及导致视觉障碍的原因.方法 12例患者经CT诊断纤维发育不良,行眼底像与光学相干断层扫描(OCT),视神经管受病变累及者行视神经管狭窄减压术.以OCT矢状面断层示筛板位于视网膜色素上皮层(RPE)上方为暴露因子,视力下降或视乳头水肿,萎缩为发病,计算Fisher精确检验和比值比.结果 CT示视神经管受病变累及致狭窄18侧:8侧视力正常,其中6侧OCT示筛板位于RPE下方,经随访1侧筛板接近RPE,1侧OCT示筛板达RPE,视乳头正常;1侧筛板位于RPE上方,视乳头水肿.视觉下降10侧,视乳头正常2侧,视乳头萎缩8侧,OCT示筛板位于RPE上方,术后OCT示筛板位于RPE下方.术后7侧眼视力好转.Fisher精确检验,P＜0.01,比值比=∞.结论视神经管狭窄导致筛板区后压力增高,筛板向RPE上方移位,通道变形,挤切视神经节细胞轴突,轴浆运输受阻,血运障碍,是导致视觉障碍的病因;手术后筛板区后压力下降,筛板恢复凹陷,通道变形恢复,视力改善.
목적 탐토섬유발육불량도치시신경관협착시시신경두부적개변급도치시각장애적원인.방법 12례환자경CT진단섬유발육불량,행안저상여광학상간단층소묘(OCT),시신경관수병변루급자행시신경관협착감압술.이OCT시상면단층시사판위우시망막색소상피층(RPE)상방위폭로인자,시력하강혹시유두수종,위축위발병,계산Fisher정학검험화비치비.결과 CT시시신경관수병변루급치협착18측:8측시력정상,기중6측OCT시사판위우RPE하방,경수방1측사판접근RPE,1측OCT시사판체RPE,시유두정상;1측사판위우RPE상방,시유두수종.시각하강10측,시유두정상2측,시유두위축8측,OCT시사판위우RPE상방,술후OCT시사판위우RPE하방.술후7측안시력호전.Fisher정학검험,P＜0.01,비치비=∞.결론 시신경관협착도치사판구후압력증고,사판향RPE상방이위,통도변형,제절시신경절세포축돌,축장운수수조,혈운장애,시도치시각장애적병인;수술후사판구후압력하강,사판회복요함,통도변형회복,시력개선.
Objective To investigate the causes for changes in optic nerve head and visual impairment caused by fibrous dysplasia (FD) of optic canal stenosis. Methods A total of 12 FD patients,diagnosed by CT, received the fundus and optical coherence tomography (OCT). Those with FD involving optic canal underwent decompression. The examination of OCT showed that lamina cribrosa located at the top was the exposure factor for retinal pigment epithelium (RPE). There were decreased vision or edematous optic nerve and atrophic lesion. Odds ratio was calculated by Fisher's exact test. Results The examination of CT showed the results of optic canal stenosis caused by lesions involving 18 sides : 8-sides with normal vision.Among which, 6 showing that lamina cribrosa was located below RPE and a lamina cribrosa plate near RPE at follow-up, 1 side OCT showing lamina cribrosa above RPE with normal optic nerve; a lateral lamina cribrosa was located above RPE with edematous optic nerve. Visual impairment at 10 sides, normal papillary 2 sides, atrophic papillary 8 sides, OCT showed that lamina cribrosa was located above RPE,postoperatively OCT showed that lamina cribrosa below with 7 sides having improved visual acuity. Fisher's exact test was performed ( P = 0. 000, odds ratio = ∞ ). Conclusion The optic canal stenosis causes a rising pressure of lamina cribrosa zone to shift above RPE. The channel becomes distorted so as to squeeze and cut the ganglion cell axons of optic nerve, block the axoplasmic transport and result in blood circulation disorder. The above factors are the etiologies of visual impairments. Postoperatively lamina eribrosa zone pressure drops so that depressed lamina cribrosa and channel deformation recover and visual acuity improves.