Purvin Valerie, King Rae, Kawasaki Aki, Yee Robert
Midwest Eye Institute, Indianapolis, IN 46280, USA.
Arch Ophthalmol. 2004 Jan;122(1):48-53. doi: 10.1001/archopht.122.1.48.
There have been anecdotal reports of anterior ischemic optic neuropathy (AION) occurring in eyes with optic disc drusen (ODD), but the clinical features of this condition have not been well characterized.
To better describe the clinical features of AION associated with ODD and to compare the clinical features of this condition with those of "garden variety" nonarteritic AION.
We reviewed the medical records of 20 patients who experienced an episode of AION in an eye with ODD. In 4 patients, both eyes were affected; thus, 24 eyes were studied. The diagnosis of ODD was made by ophthalmoscopic identification, orbital ultrasonography, or computed tomographic scanning. We recorded age, sex, vascular risk factors, symptoms, visual acuity, visual fields, and results of the follow-up examination in all patients. These findings were compared with data from previously reported series of patients with nonarteritic AION.
Our 20 patients included 14 men and 6 women (age range, 18-69 years; mean, 49.4 years). Vascular risk factors were identified in 10 patients (50%). Three patients reported episodes of transient visual loss before their fixed deficit. The visual acuity at the initial examination was 20/60 or better in 15 (62%) of the 24 eyes; 8 had a visual acuity of 20/20. The predominant pattern of visual field loss was an altitudinal or arcuate defect in 19 (79%) and a centrocecal scotoma in 5 (21%) of the 24 eyes. There was subjective worsening of vision before the initial neuro-ophthalmic examination in 11 eyes (46%) and objective documentation of progression in 7 eyes (29%). The final visual acuity was 20/40 or better in 13 (62%) of 21 eyes and 20/200 or worse in 3 (14%) of 21 eyes.
Our patients were strikingly similar to those with nonarteritic AION unassociated with drusen in regard to prevalence of vascular risk factors, pattern of visual field loss, and occurrence of a subsequent similar event in the fellow eye. In contrast, however, patients with ODD-AION were younger than those with nonarteritic AION, were more likely to report preceding episodes of transient visual obscuration, and enjoyed a more favorable visual outcome.
有零星报道称视盘玻璃疣（ODD）患者的眼睛会发生前部缺血性视神经病变（AION），但这种疾病的临床特征尚未得到充分描述。
更好地描述与ODD相关的AION的临床特征，并将这种疾病的临床特征与“普通类型”非动脉炎性AION的临床特征进行比较。
我们回顾了20例在患有ODD的眼睛中发生AION发作的患者的病历。其中4例患者双眼均受累；因此，共研究了24只眼睛。ODD的诊断通过检眼镜检查、眼眶超声检查或计算机断层扫描做出。我们记录了所有患者的年龄、性别、血管危险因素、症状、视力、视野以及随访检查结果。将这些结果与先前报道的非动脉炎性AION患者系列的数据进行比较。
我们的20例患者包括14名男性和6名女性（年龄范围18 - 69岁；平均49.4岁）。10例患者（50%）存在血管危险因素。3例患者在出现固定视力缺损之前报告有短暂性视力丧失发作。24只眼中有15只（62%）在初次检查时视力为20/60或更好；8只眼视力为20/20。24只眼中有19只（79%）视野缺损的主要模式为象限性或弓形缺损，5只（21%）为中心暗点。11只眼（46%）在初次神经眼科检查前视力主观恶化，7只眼（29%）有病情进展的客观记录。21只眼中有13只（62%）最终视力为20/40或更好，3只眼（14%）最终视力为20/200或更差。
我们的患者在血管危险因素患病率、视野缺损模式以及对侧眼随后发生类似事件方面与未合并玻璃疣的非动脉炎性AION患者极为相似。然而，相比之下，ODD - AION患者比非动脉炎性AION患者更年轻，更有可能报告先前有短暂性视力模糊发作，并且视力预后更好。
