摘要
目的观察并分析非动脉炎性前部缺血性视神经病变(NAION)患者的临床特征和误诊原因。方法回顾性病例研究。2014年11月至2022年7月于兰州市第一人民医院眼科检查确诊的NAION患者49例49只眼纳入研究。所有患者首诊均被误诊为其他眼部疾病。所有患眼均行最佳矫正视力(BCVA)、相对性传入性瞳孔障碍(RAPD)、眼底彩色照相、眼眶核磁共振成像(MRI )、视野、光相干断层扫描(OCT)、图形视觉诱发电位(P-VEP)检查。同时行荧光素眼底血管造影(FFA)检查32只眼。回顾分析患者临床及MRI、视野、P-VEP、FFA等特征。结果 49例患者中, 男性31例, 女性18例;均为单眼发病;年龄(59.3±7.8)岁。均主诉单眼无痛性视力下降或视物遮挡感。出现症状至就诊时病程>2个月、≤2个月分别为12 (24.5%, 12/49)、37 (75.6%, 37/49)例。49只眼中, 误诊为视神经炎、正常眼压性青光眼(NTG)或疑似青光眼、视盘血管炎、白内障、糖尿病视网膜病变、外伤性视神经病变、中毒性视神经病变分别为28 (57.1%, 28/49)、11 (22.4%, 11/49)、5 (10.2%, 5/49)、2 (4.1%, 2/49)、1 (2.0%, 1/49 )、1 (2.0%, 1/49)、1 (2.0%, 1/49)只眼。BCVA<0.1、0.1~ 0.5、>0.5者分别为24 (49.0%, 24/49 )、16 (32.7%, 16/49)、9 (18.4%, 9/49)只眼。RAPD阳性45只眼(91.8%, 45/49)。伴、不伴视盘水肿分别为37 (75.6%, 37/49)、12 (24.5%, 12/49)只眼;伴有视盘表面及视盘周围(盘周)出血15只眼(30.6%, 15/49)。MRI检查, 所有患眼视神经段未见明显异常。OCT检查伴视盘水肿的37只眼视网膜神经纤维层增厚, 为(307.1±62.1)μm。视野检查, 表现为典型的与生理盲点相连的绕过中心注视点的下方视野缺损24只眼(49.0%, 24/49 ), 与生理盲点相连的局限性视野缺损6只眼(12.2%, 6/49 ), 弥漫性视野缺损19只眼(38.8%, 19/49)。P-VEP检查, 所有患眼P100波振幅中至重度下降;峰时轻度延迟24只眼(49.0%, 24/49), 峰时中度延迟11只眼(22.4%, 11/49)。行FFA检查的32只眼, 动脉早期盘周局限或弥漫性充盈延迟, 中期相应区域荧光素渗漏。结论 NAION患者以单眼无痛性视力下降或视物遮挡感为主要症状, 临床主要特征为视野缺损、视网膜神经纤维层增厚及视觉电生理异常。急性或亚急性视力下降并伴有视盘水肿和(或)出血的NAION患者易被误诊为视神经炎、视神经血管炎、其他类型视神经病变等;病程>2个月易误诊为NTG。
Objective To observed and analyze the clinical features of patients with nonarteritic anterior ischemic optic neuropathy(NAION)causes of misdiagnosis.Methods A retrospective case study.From November 2014 to July 2022,49 NA10N patients with 49 eyes diagnosed in Department of Ophthalmology,The First People's Hospital of Lanzhou were included in the study.All patients were misdiagnosed with other eye diseases at first diagnosis.All eyes were examined by best corrected visual acuity(BCVA),relative afferent pupil defect(RAPD),orbital magnetic resonance imaging(MRI),visual field,optical coherence tomography(OCT),and graphic visual evoked potential(P-VEP).Fluorescein fundus angiography(FFA)was performed in 32 eyes.Clinical and MRI,visual field,P-VEP、FFA features of the patients were retrospectively analyzed.Results There were 31 males and 18 females among the 49 patients.All cases were monocular.Age was(59.3±7.8)years.All of them complained of painless visual acuity loss or occlusion sensation in one eye.There were 12(24.5%,12/49)and 37(75.6%,37/49)cases with disease duration>2 months and≤2 months,respectively.In 49 eyes,misdiagnosed as optic neuritis,normal tension glaucoma(NTG)or suspected glaucoma,optic disc vasculitis,cataract,diabetic retinopathy,traumatic optic neuropathy and toxic optic neuropathy were 28(57.1%,28/49),11(22.4%,11/49),5(10.2%,5/49),2(4.1%,2/49),1(2.0%,1/49),1(2.0%,1/49),1(2.0%,1/49)eyes.24(49.0%,24/49),16(32.7%,16/49)and 9(18.4%,9/49)eyes had BCVA<0.1,0.1-0.5 and>0.5,respectively.RAPD was positive in 45 eyes(91.8%,45/49).There were 37(75.6%,37/49)and 12(24.5%,12/49)eyes with and without optic disc edema,respectively.Bleeding was observed on and around the optic disc in 15 eyes(30.6%,15/49).MRI examination showed no obvious abnormality in the optic nerve segments of all affected eyes.OCT showed an increase in retinal nerve fiber layer thickness(307.1±62.1)μm in 37 patients with optic disc edema.The visual field examination showed that 24 eyes(49.0%,24/49)had typical lower visual field defect connected with the physiological blind spot and circumvented the central fixation point,6 eyes(12.2%,6/49)had limited visual field defect connected with the physiological blind spot,and 19 eyes(38.8%,19/49)had diffuse visual field defect.By P-VEP examination,the amplitude of P100 wave decreased moderately to severely in all affected eyes.There were 24 eyes(49.0%,24/49)with mild peak delay and 11 eyes(22.4%,11/49)with moderate peak delay.In 32 eyes examined by FFA,the arteries had early peridisk limitation or diffuse delayed filling,and mid-course fluorescein leakage in the corresponding area.Conclusions The main symptoms of NAION patients are painless visual acuity loss in one eye or occlusion of vision.The main clinical features of NAION patients are visual field defect,retinal nerve fiber layer thickening and visual electrophysiological abnormalities.NAION patients with acute or subacute visual loss accompanied by optic disc edema and/or bleeding are often misdiagnosed as optic neuritis,optic neurovasculitis and other types of optic neuropathy.NAION patients with a disease course of>2 months are easily misdiagnosed as NTG.
作者
王雪琼
陈菲
李辰
王延鹏
Wang Xueqiong;Chen Fei;Li Chen;Wang Yanpeng(Department of Ophthalmology,The First People's Hospital of Lanzhou,Lanzhou 730000,China)
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2023年第11期893-897,共5页
Chinese Journal of Ocular Fundus Diseases
