前部缺血性视神经病变视盘颜色、视功能及盘周神经纤维厚度的随访分析

The Changes of Optic Disc Color and Visual Function and Peripheral Nerve Fiber Thickness in Patients with Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) in Long-Time Follow Up

摘要: 目的：追踪观察非动脉炎性前部缺血性视神经病变(NAION)水肿消退期后视盘颜色、中心视力、视野及盘周神经纤维(NFL)厚度变化。方法：对NAION水肿消退后的患者145例147只眼进行视盘颜色、中心视力、视野以及视盘周围NFL厚度的连续观察，按随访时间分组：6~12月内为A组147只眼、12~24月内为B组121只眼、24月以上为C组94只眼，对其结果进行统计分析。结果：NAION视盘色泽全部色淡A组占15.0%、B组16.5%、C组18.1%；三组中心视力分布均无差异(P > 0.05)，视野改变比较有差异(P < 0.05)；A组视盘全周及各象限RNFL厚度均薄于正常人(P < 0.05)，视盘全周RNFL厚度均值A与B组无差异(P > 0.05)，C < B组(P < 0.05)，鼻侧象限RNFL厚度均值各组均无差异(P > 0.05)，颞、上、下象限RNFL厚度均值C < B < A组(P < 0.05)。结论：NAION水肿消退后随时间延续中心视力相对稳定，视野损伤加重，盘周RNFL厚度呈逐渐变薄趋势。

Abstract: Objective: To observe the changes of optic disc color and visural function and peripheral retinalnerve fiber thickness in patients with nonarteritic anterior ischemic optic neuropathy (NAION) in long-time follow up. Methods: 145 cases 147 eyes have diagnosised as NAION at resolving stage, and followed up by visual acuity, visual field (Humphrey), the tomography of disc (Topcon 50EX fundus camera) and TOPCON OCT examination system at diffrernt period of follow up respectively. 6 - 12 months of follow-up 147 eyes as A group, 12 - 24 months 121 eyes as B group , and above 24 monthes 94 eyes as C group (a maximum of 60 months, an average of 34 months). Three stages of the observed results were analyzed. Results: The whole optic disc in pale with A, B, C groups showed 15.0、16.5、18.1 percent respectively. The results in visual acuity showed no significant difference each other (P > 0.05) and there were significant difference in visual field (P < 0.05). Comparion group A to normal control group in mean peripheral RNFl thickness and each quadrant RNFl thickness were statistical significance(P < 0.05); Exception for nasal quadrant, other three quadrants comparison with groups showed that Group C is thinner than Group B, Group B is thinner than Group A. Conclusion: In the long-time follow up after resolving period, the visual field affected NAION changed worse in spite of visual acuity relative stable, and its peripapillary RNFl thickness showed a declining trend.