59例因视神经损害致无光感病例临床疗效评价分析
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摘要
目的探讨不同病因视神经损害致无光感病例临床治疗效果,为该类患者治疗时机提供参考依据。方法回顾分析我院近5年来视神经损害无光感病例的发病时间与治疗效果相关性,不同病因对视力恢复情况影响,以及采用的临床治疗方案和效果。结果纳入病例共计59例(73只眼)。其中外伤26例(31只眼),有视力恢复者共4只眼,总有效率12.90%。视神经炎17例(20只眼),视力恢复共11只眼,总有效率为55.00%。颅脑占位术后13例(19只眼),有视力恢复者1例(1只眼),有效率5.26%。放射性视神经病变3例(3只眼),无视力恢复者。外伤性视神经病变无光感者患病初期行糖皮质激素冲击或视神经管减压术,比无此治疗的患者更容易视力恢复(P<0.05)。视神经炎患者在大剂量糖皮质激素冲击期比无此治疗的患者更容易视力恢复(P<0.05)。结论无光感视神经损害患者,病因不同视力恢复概率不同;外伤性视神经病变患者视力损害超过1个月以及视神经炎患者视力损害超过2个月后,再恢复出现光感的概率极低。儿童视神经损害后视力恢复与成人可能存在差异。
OBJECTIVE To explore the clinical therapeutic effect of no light perception cases due to optic nerve damage in different etiologies, and to provide references for the treatment opportunity of such patients. METHODS A retrospective study was carried out to analyze the correlation between the onset time and therapeutic effect of patients with no light perception due to optic nerve damage in our hospital to study the impact of different causes on visual recovery and their therapeutic plan and curative effects. RESULTS A total of 59 cases(73 eyes) were included.Among them, 26 cases(31 eyes) were injured, and 4 of them enjoyed vision recovery, the total effective rate was 12.90%; 17 cases of optic neuritis(20 eyes), and 11 eyes got visual recovery, the total effective rate was 55.00%; 13 cases(19 eyes) were secondary to craniocerebral space occupying lesion, one patient(1 eye) got vision recovery and the total effective rate was 5.26%; 3 cases(3 eyes) with radiation optic neuropathy and none of them got visual recovery. Patients with traumatic optic neuropathy without light sensation at the initial stage of the disease underwent hormone therapy or optic tube decompression. Compared with patients treated by other methods, the odds of visual recovery in patients underwent hormone therapy and decompression were of higher probability of vision recovery(P<0.05). Patients with optic neuritis were more likely to restore visual acuity during high-dose hormone therapy than patients on other medication(P<0.05). CONCLUSIONS In patients with severe sensorineural optic nerve damage, the odds of vision recovery were different according to different etiologies. For patients with traumatic optic neuropathy with impaired vision for more than 1 month, and patients with optic neuritis wi th impaired vision for more than 2 months, the probability of regaining a sense of light was extremely low. There might be differences in visual recovery degree after optic nerve damage between children and adult patients.
OBJECTIVE To explore the clinical therapeutic effect of no light perception cases due to optic nerve damage in different etiologies, and to provide references for the treatment opportunity of such patients. METHODS A retrospective study was carried out to analyze the correlation between the onset time and therapeutic effect of patients with no light perception due to optic nerve damage in our hospital to study the impact of different causes on visual recovery and their therapeutic plan and curative effects. RESULTS A total of 59 cases(73 eyes) were included.Among them, 26 cases(31 eyes) were injured, and 4 of them enjoyed vision recovery, the total effective rate was 12.90%; 17 cases of optic neuritis(20 eyes), and 11 eyes got visual recovery, the total effective rate was 55.00%; 13 cases(19 eyes) were secondary to craniocerebral space occupying lesion, one patient(1 eye) got vision recovery and the total effective rate was 5.26%; 3 cases(3 eyes) with radiation optic neuropathy and none of them got visual recovery. Patients with traumatic optic neuropathy without light sensation at the initial stage of the disease underwent hormone therapy or optic tube decompression. Compared with patients treated by other methods, the odds of visual recovery in patients underwent hormone therapy and decompression were of higher probability of vision recovery(P<0.05). Patients with optic neuritis were more likely to restore visual acuity during high-dose hormone therapy than patients on other medication(P<0.05). CONCLUSIONS In patients with severe sensorineural optic nerve damage, the odds of vision recovery were different according to different etiologies. For patients with traumatic optic neuropathy with impaired vision for more than 1 month, and patients with optic neuritis wi th impaired vision for more than 2 months, the probability of regaining a sense of light was extremely low. There might be differences in visual recovery degree after optic nerve damage between children and adult patients.
引文
[1] DANESH-MEYER HV.Radiation induced optic neuropathy[J].J Clin Neurosci,2008,15(2):95-100.
[2]韦企平.外伤性视神经病变的诊断和治疗进展[J].中国中医眼科杂志2017,27(6):351-354.
[3]姜利斌,王倩,魏文斌.视神经炎分类与鉴别诊断[J].眼科,2013,22(6):364-369.
[4]田国红,孙兴怀.压迫性视神经病的诊断要点[J].中国眼耳鼻喉科杂志,2015,15(1):65-70.
[5]国家中医药管理局.中医病症诊断疗效标准[S].南京:南京大学出版社,1994:113.
[6] ISCHEMIC OPTIC NEUROPATHY DECOMPRESSION TRIAL STUDY GROUP. Characterstics of patients with nonarteritic ischemic optic neuropathy eligible for the Ischemic Optic Neuropathy Decompression Trial[J]. Arch Ophthalmol,1996, 114(11):1366-1374.
[7] TSAQKATAKI M,ROWLANDS A. Visual Loss due to Non-arteritic anterior ischemic optic neuropathy(NAION)immediately following routine strabismus surgery under general anesthesia—a case report[J]. Strabismus,2012,20(3):121-123.
[8] VOTRUBA M,FITZKE FW,HOLDER GE,et al. Clinical features in affected individuals from 21 pedigrees with dominant optic atrophy[J].Arch Ophthalmol,1998,116(3):351-358.
[9] KANAMORI A, NAKAMURA M, YAMADA Y,et al.Longitudinal study of retinal nerve fiber layer thickness and ganglion cell complex in traumatic optic neuropathy[J]. Arch Ophthalmol,2012,130(8):1067-1069.
[10]宋维贤,孙华.不同入路视神经管减压开放术疗效分析[J].眼科,2002,11(5):286-288.
[11]刘在尧,何晓冉,丁宁.非手术治疗无光感外伤性视神经病变[J].中国医药导报,2013,10(28):63-65.
[12] TROBE JD,SIEVING PC,GUIRE KE,et al. The impact of the optic neuritis treatment trial on the practices of ophthalmologists and neurologists[J]. Ophthalmology,1999,106(11):2047-2053.
[13]乔喜珍.甲基强的松龙综合治疗无光感球后视神经炎的临床研讨[J].中国现代药物应用,2009,3(9):126-127.
[14]陈学超.颅咽管瘤右眼失明4个月术后视力恢复一例报告[J].广州医药,1981,12(4):42.
[15] INDARAM M,ALI FS, LEVIN MH. In search of a treatment for radiation-induced optic neuropathy[J]. Curr Treat Options Neurol,2015,17(1):325.
[2]韦企平.外伤性视神经病变的诊断和治疗进展[J].中国中医眼科杂志2017,27(6):351-354.
[3]姜利斌,王倩,魏文斌.视神经炎分类与鉴别诊断[J].眼科,2013,22(6):364-369.
[4]田国红,孙兴怀.压迫性视神经病的诊断要点[J].中国眼耳鼻喉科杂志,2015,15(1):65-70.
[5]国家中医药管理局.中医病症诊断疗效标准[S].南京:南京大学出版社,1994:113.
[6] ISCHEMIC OPTIC NEUROPATHY DECOMPRESSION TRIAL STUDY GROUP. Characterstics of patients with nonarteritic ischemic optic neuropathy eligible for the Ischemic Optic Neuropathy Decompression Trial[J]. Arch Ophthalmol,1996, 114(11):1366-1374.
[7] TSAQKATAKI M,ROWLANDS A. Visual Loss due to Non-arteritic anterior ischemic optic neuropathy(NAION)immediately following routine strabismus surgery under general anesthesia—a case report[J]. Strabismus,2012,20(3):121-123.
[8] VOTRUBA M,FITZKE FW,HOLDER GE,et al. Clinical features in affected individuals from 21 pedigrees with dominant optic atrophy[J].Arch Ophthalmol,1998,116(3):351-358.
[9] KANAMORI A, NAKAMURA M, YAMADA Y,et al.Longitudinal study of retinal nerve fiber layer thickness and ganglion cell complex in traumatic optic neuropathy[J]. Arch Ophthalmol,2012,130(8):1067-1069.
[10]宋维贤,孙华.不同入路视神经管减压开放术疗效分析[J].眼科,2002,11(5):286-288.
[11]刘在尧,何晓冉,丁宁.非手术治疗无光感外伤性视神经病变[J].中国医药导报,2013,10(28):63-65.
[12] TROBE JD,SIEVING PC,GUIRE KE,et al. The impact of the optic neuritis treatment trial on the practices of ophthalmologists and neurologists[J]. Ophthalmology,1999,106(11):2047-2053.
[13]乔喜珍.甲基强的松龙综合治疗无光感球后视神经炎的临床研讨[J].中国现代药物应用,2009,3(9):126-127.
[14]陈学超.颅咽管瘤右眼失明4个月术后视力恢复一例报告[J].广州医药,1981,12(4):42.
[15] INDARAM M,ALI FS, LEVIN MH. In search of a treatment for radiation-induced optic neuropathy[J]. Curr Treat Options Neurol,2015,17(1):325.