【摘要】 目的观察不同时期的前部缺血性视神经病变(AION)患者的视功能及视盘、黄斑组织结构的变化特点。方法收集2015年12月—2017年12月符合纳入标准的AION患者17例(17只眼),设为观察组。将同一时期经门诊筛查为正常眼的受试者的右眼17例(17只眼)设为对照组。观察组予西医常规治疗,对照组不予干预。观察2组受试者的最佳矫正视力(BCVA)、视野平均缺损(MD)、视盘周神经纤维(p RNFL)厚度和黄斑区神经节细胞复合体(mGCC)厚度的变化情况。结果 (1)BCVA:与对照组比较,早、中、晚期较差,差异均有统计学意义(P<0.05)。与早期比较,中期和晚期视力改善,差异有统计学意义(P<0.05)。晚期与中期比较,差异无统计学意义(P>0.05)。(2)视野:与对照组MD比较,观察组早、中、晚期绝对值均减小,差异均有统计学意义(P<0.05)。与早期比较,中期和晚期均改善,差异均有统计学意义(P<0.05)。与中期比较,晚期无明显变化,差异无统计学意义(P>0.05)。观察组中,典型AION视野缺损(15只眼)占比88.24%,其他类型缺损(2只眼)占比11.76%。(3)pRNFL:与对照组比较,早期变厚,晚期变薄,差异均有统计学意义(P<0.05);中期无明显变化,差异无统计学意义(P>0.05)。观察组治疗前后比较,随病程增加,逐渐变薄,差异均有统计学意义(P<0.05)。(4)mGCC厚度:与对照组比较,早期变厚,中、晚期变薄,差异均有统计学意义(P<0.05)。观察组治疗前后比较,随病程增加,逐渐变薄,除中、晚期无差异外,其他均有统计学意义(P<0.05)。结论 AION的BCVA和视野MD在中晚期改善且平稳,与中晚期pRNFL和mGCC的改变一致。mGCC的萎缩改变早于p RNFL的萎缩改变,且在AION病程的中、晚期趋于稳定。更多还原

【Abstract】 OBJECTIVE To observe the changes of optic function and the structure of optic disc and macula in different stages of anterior ischemic optic neuropathy(AION). METHODS 17 AION patients(17 eyes) who met the inclusion criteria from December 2015 to December 2017 were screened out as the observation group. The right eyes of 17 patients(17 eyes) who were recruited as normal eyes in outpatient department at the same period were set as the control group. The observation group accepted routine oral corticosteroid treatment,and the control group was not intervened. The best corrected visual acuity(BCVA), visual field mean defect(MD), the thickness of peripapillary optic fiber layer(pRNFL) and macular ganglion cell complex(mGCC) were observed.RESULTS(1) BCVA: Compared with the control group, BCVA in the early, middle and late stage were worse, and the differences were statistically significant(P<0.05). Compared with the early stage,the visual acuity improved in the middle and late stage, the difference was statistically significant(P<0.05). But there was no significant difference between the late stage and the middle stage(P>0.05).(2) Visual field: Compared with the control group, MD in the early, middle and late stage in the observation group were decreased, and the differences were statistically significant(P<0.05). Compared with the early stage, MD in the middle and late stages were improved, and the differences were statistically significant(P<0.05). There was no significant difference between the middle and the late stage(P>0.05). In the observation group, 88.24% of typical AION visual field defects(15 eyes) and11.76% of other types of visual field defects(2 eyes) were observed.(3) The thickness of p RNFL:Compared with the control group, the thickness of p RNFL was thicker in the early stage, but thinner in the late stage, and the differences were statistically significant(P<0.05). But there was no significant difference in the middle stage when compared with the control group(P>0.05). The thickness of p RNFL in the observation group was gradually thinner in the course of AION, and the differences between before and after treatment were statistically significant(P<0.05).(4) The thickness of m GCC:Compared with the control group, m GCC was thicker in the early stage, thinner in the middle and late stage, and the differences were statistically significant(P<0.05). The thickness of m GCC in the observation group was gradually thinner in the course of AION. The differences were statistically significant in all groups except between the middle stage and late stage(P<0.05). CONCLUSIONS The BCVA and MD of AION were improved and stable in the middle and late stage, which was consistent with the changes of p RNFL and m GCC in the middle and late stage. The atrophy of m GCC was earlier than that of p RNFL, and tended to be stable in the middle and late stage of AION.更多还原