Rath E Z, Rehany U, Linn S, Rumelt S
Department of Ophthalmology, Western Galilee Medical Center, Nahariya, Israel.
Eye (Lond). 2003 Nov;17(9):1019-24. doi: 10.1038/sj.eye.6700691.
The morphologic features of swollen disc in the acute stage of optic neuritis and anterior ischaemic optic neuropathy (AION) have been extensively investigated in contrast to the morphologic features of optic disc atrophy after these events.
: A prospective study to evaluate the morphologic features of optic disc atrophy 6 months or more after optic neuritis and nonarteritic AION.
A total of 35 optic discs after nonarteritic AION (n=27) and 24 after optic neuritis (n=19) in otherwise healthy subjects have been evaluated by direct fundoscopic examination with a +90 diopters lens and optic disc photography. The average age of patients at the onset of AION was 57.8 years (range: 38-80) and at the onset of optic neuritis was 32.6 (range: 19-46). The female:male ratio was 18 : 17 in the former and 15 : 9 in the latter. The evaluated parameters included: degree of rim pallor (0 to +3), location of rim pallor, height of rim above the retina, depth and width of cup, peripapillary retinal artery to vein (A : V) ratio, and peripapillary pigment epithelial atrophy. A comparison was made also with 17 age-matched normal discs of 17 patients. Statistical significance was calculated with chi(2) and Fisher's exact test.
Most of the discs after AION were paler (+2: 70%, +3: 26%) than after optic neuritis (normal colour: 8%, +1: 58%, P< or =0.007). Rim segmental involvement after AION was usually either superior 'altitudinal' (53%) or inferior 'altitudinal' (29%), whereas after optic neuritis, it was usually either temporal-central (papillomacular) (42%) or diffuse temporal (42%, P<0.0001). Discs had lower A : V ratio (1 : 3, 40%) after AION compared with optic neuritis (1 : 3, 8%) (P=0.007). There were no significant differences between the two groups in height of the rim, cupping, and peripapillary atrophy.
: A combination of the degree of rim pallor, location of rim pallor, and A : V ratio may be of value in assessing the aetiology of optic disc atrophy when no previous clinical data are available and a compressive lesion has been ruled out.
与视神经炎和前部缺血性视神经病变（AION）急性期肿胀视盘的形态学特征相比，这些病变后视盘萎缩的形态学特征已得到广泛研究。
一项前瞻性研究，评估视神经炎和非动脉炎性AION后6个月或更长时间视盘萎缩的形态学特征。
通过使用+90屈光度镜片的直接检眼镜检查和视盘摄影，对35例非动脉炎性AION（n = 27）和24例视神经炎（n = 19）后的视盘进行评估，这些患者均为健康受试者。AION发病时患者的平均年龄为57.8岁（范围：38 - 80岁），视神经炎发病时患者的平均年龄为32.6岁（范围：19 - 46岁）。前者的男女比例为18:17，后者为15:9。评估参数包括：视盘边缘苍白程度（0至 +3）、边缘苍白的位置、视盘边缘高于视网膜的高度、杯盘深度和宽度、视乳头周围视网膜动静脉（A:V）比值以及视乳头周围色素上皮萎缩。还与17例年龄匹配的正常视盘进行了比较。采用卡方检验和Fisher精确检验计算统计学意义。
与视神经炎后相比，AION后的大多数视盘更苍白（+2：70%，+3：26%）（视神经炎后正常颜色：8%，+1：58%，P≤0.007）。AION后视盘边缘节段性受累通常为上方“象限性”（53%）或下方“象限性”（29%），而视神经炎后通常为颞侧中央（视乳头黄斑束）（42%）或弥漫性颞侧（42%，P<0.0001）。与视神经炎（1:3，8%）相比，AION后视盘的A:V比值更低（1:3，40%）（P = 0.007）。两组在视盘边缘高度、杯盘形成和视乳头周围萎缩方面无显著差异。
当没有既往临床数据且已排除压迫性病变时，视盘边缘苍白程度、边缘苍白位置和A:V比值的组合可能有助于评估视盘萎缩的病因。
