CAJ | 학술논문

目的探讨不伴有明显视乳头萎缩改变的慢性压迫性视神经病变的临床特征.方法回顾性系列病例研究.收集2005年8月至2014年3月就诊于首都医科大学附属北京同仁医院北京同仁眼科中心,发病病程6个月及以上,因眼底正常或改变轻微而被漏诊或误诊为其他眼科疾病,最终确诊为压迫性视神经病变的25例患者(37只眼)的临床资料.分析其症状、视力、视野、神经影像学和(或)病理学诊断结果.结果 25例患者中男性5例,女性20例,就诊时年龄9.0 ～74.0岁,平均(47.5±13.4)岁;在临床症状上,患者均表现为单眼或双眼进行性视力下降,不伴眼球突出或运动障碍,除1例患者伴有头痛外其余无全身症状;就诊时患眼矫正视力:眼前手动至1.0不等,眼底视乳头形态和颜色正常;经神经影像学和(或)病理学检查,确诊25例患者中患鞍结节脑膜瘤14例,垂体瘤5例,眶尖部视神经鞘脑膜瘤3例,眶尖部海绵状血管瘤1例,眶尖部血管畸形1例,视神经胶质瘤1例;在19例鞍区占位病变患者中,14例曾行视野检查,仅有4例患者表现出典型视交叉病变视野缺损特征.结论隐匿性进行性视功能损伤是该类疾病最重要的临床特征.
목적 탐토불반유명현시유두위축개변적만성압박성시신경병변적림상특정.방법 회고성계렬병례연구.수집2005년8월지2014년3월취진우수도의과대학부속북경동인의원북경동인안과중심,발병병정6개월급이상,인안저정상혹개변경미이피루진혹오진위기타안과질병,최종학진위압박성시신경병변적25례환자(37지안)적림상자료.분석기증상、시력、시야、신경영상학화(혹)병이학진단결과.결과 25례환자중남성5례,녀성20례,취진시년령9.0 ～74.0세,평균(47.5±13.4)세;재림상증상상,환자균표현위단안혹쌍안진행성시력하강,불반안구돌출혹운동장애,제1례환자반유두통외기여무전신증상;취진시환안교정시력:안전수동지1.0불등,안저시유두형태화안색정상;경신경영상학화(혹)병이학검사,학진25례환자중환안결절뇌막류14례,수체류5례,광첨부시신경초뇌막류3례,광첨부해면상혈관류1례,광첨부혈관기형1례,시신경효질류1례;재19례안구점위병변환자중,14례증행시야검사,부유4례환자표현출전형시교차병변시야결손특정.결론 은닉성진행성시공능손상시해류질병최중요적림상특정.
Objective To investigate the clinical feature of the chronic compressive optic neuropathy without optic atrophy.Methods Retrospective cases series study.The clinical data of 25 patients (37 eyes) with chronic compressive optic neuropathy without optic atrophy,treated in Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,from October,2005 to March,2014,were collected.Those patients had been showing visual symptoms for 6 months or longer,but missed diagnosed or misdiagnosed as other eye diseases due to their normal or slightly changed fundi.The collected data including visual acuities,visual fields,neuroimaging and/or pathologic diagnosis were analyzed.Results Among the 25 patients,there were 5 males and 20 females,and their ages range from 9 to 74 years [average (47.5 ± 13.4) years].All patients suffered progressive impaired vision in single eye or both eyes,without exophthalmos or abnormal eye movements.Except one patient had a headache,other patients did not show systemic symptoms.The corrected visual acuities were between HM to 1.0,and their appearances of optic discs and colors of fundi were normal.After neuroimaging and/or pathological examination,it was proven that 14 patients suffered tuberculum sellae meningiomas,5 patients with hypophysoma,3 patient with optic nerve sheath meningioma in orbital apex,1 patient with cavernous hemangioma,1 patient with vascular malformation in orbital apex and 1 patient with optic nerve glioma.Among the 19 patients whose suffered occupied lesions of saddle area,14 patients underwent visual field examinations,and only 4 patients showed classic visual field defects caused by optic chiasmal lesions.Conclusion Occult progressive visual loss was the most important clinical feature of the disease.