放射性视神经病变的诊疗特征
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Diagnosis and treatment characteristics of radioactive optic neuropathy
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    摘要:

    目的:通过17例放射性视神经病变(radiation-induced optic neuritis,RION)患者的临床资料探讨其诊疗特征及方法。

    方法:回顾性病例分析研究,对2008-08/2013-10中国人民解放军总医院17例经视力、瞳孔、眼底、视野、造影、视觉电生理、头颅核磁等检查确诊的17例24眼RION患者的临床资料进行分析。对确诊为RION患者的临床资料数据进行统计学描述。

    结果:视力损伤程度为13眼Ⅳ度,9眼Ⅲ度,2眼Ⅱ度。10眼RAPD(+),视觉电生理为熄灭型,5眼视网膜上可以见到点状或火焰状出血,以及棉絮样渗出,1眼为视乳头水肿。核磁共振(MRI):19眼T1加权像增强,视神经眶内段及管内段异常改变; 视交叉、垂体柄可探及信号改变。视神经段增粗等改变,5眼观察到扭曲的视神经及其粗糙的边缘。治疗效果,4眼视力提高,1眼从无光感至有光感,1眼视力从0.08升至0.2,1眼视力从0.4升至0.6,1眼视力从0.04升至0.15,余治疗未见任何改善。

    结论:RION的独特临床表现可为临床及时诊断提供客观依据,但对于RION的治疗效果不理想。

    Abstract:

    AIM: To explore the diagnosis and treatment methods of radioaction-induced optic neuritis(RION)through the clinical dates of 17 patients.

    METHODS: It was a retrospective case series study. From August 2008 to October 2013, 17 cases(24 eyes)of Rion clinical dates from Chinese PLA General Hospital were studied. The diagnosis methods including visual acuity, pupil, fundus, visual field, fundus fluorescein angiography(FFA), visual electrophysiological testing, and head MRI. To analysis the clinical date of patients with diagnosis of RION by statistical description.

    RESULTS: The deterioration degree of vision: 13 eyes were classified as Ⅳ, 9 eyes as Ⅲ, 2 eyes as Ⅱ. Ten eyes RAPD(+), visual electrophysiology is extinguished. The retina of 5 eyes showed flame hemorrhages and cotton wool spots exudation. Optic nerve head edema in one eye. T1-weighted MRI enhanced in 19 eyes which showed optic nerve of the intracranial and intratubal segments abnormal changed, optic chiasm and pituitary stalk signal abnormalities and enhancement of the optic nerve. Tortuous optic nerves and rough edges were observed in 5 eyes. Treatment effect: 4 eyes of visual acuity improved, 1 eye from blindness to light perception,1 eye from 0.08 to 0.2, 1 eye from 0.4 to 0.6,1 eye from 0.04 to 0.15, the rest of the cases did not see any improvement.

    CONCLUSION: The unique clinical manifestation of RION can provide objective basis for clinical diagnosis in time, but there have not been proven any effective treatments.

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张燕,李红阳,彭春霞,等.放射性视神经病变的诊疗特征.国际眼科杂志, 2014,14(6):1095-1099.

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  • 收稿日期:2014-02-18
  • 最后修改日期:2014-05-06
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  • 在线发布日期: 2014-05-22
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